- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $886.00 / $2,663.12 / $3,693.00
| Facility | | $886.00 | $2,663.12 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.29 / $239.76 / $368.55
| Professional | | $213.29 | $239.76 | $368.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $514.65 / $3,818.90 / $12,379.00
| Facility | | $514.65 | $3,818.90 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.35 / $457.93 / $2,799.69
| Professional | | $206.35 | $457.93 | $2,799.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.58 / $419.32 / $557.26
| Professional | | $319.58 | $419.32 | $557.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.73 / $428.51 / $790.14
| Professional | | $292.73 | $428.51 | $790.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $217.52 / $457.40 / $6,679.00
| Facility | | $217.52 | $457.40 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.43 / $244.71 / $394.51
| Professional | | $131.43 | $244.71 | $394.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.42 / $529.35 / $765.70
| Professional | | $265.42 | $529.35 | $765.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,863.50 / $3,863.50 / $7,075.34
| Facility | | $3,863.50 | $3,863.50 | $7,075.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.03 / $365.03 / $405.04
| Professional | | $365.03 | $365.03 | $405.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $4,525.00 / $16,394.00
| Facility | | $1,061.00 | $4,525.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.63 / $503.72 / $2,799.69
| Professional | | $245.63 | $503.72 | $2,799.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.79 / $390.89 / $723.79
| Professional | | $242.79 | $390.89 | $723.79 |