- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $233.61 / $2,663.12 / $4,410.00
| Facility | | $233.61 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.30 / $241.61 / $488.59
| Professional | | $202.30 | $241.61 | $488.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.99 / $3,372.00 / $10,821.00
| Facility | | $524.99 | $3,372.00 | $10,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.19 / $496.68 / $1,985.92
| Professional | | $216.19 | $496.68 | $1,985.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.34 / $325.44 / $574.28
| Facility | | $250.34 | $325.44 | $574.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.14 / $420.65 / $883.23
| Professional | | $298.14 | $420.65 | $883.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.68 / $471.42 / $933.11
| Professional | | $271.68 | $471.42 | $933.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.89 / $456.46 / $6,679.00
| Facility | | $215.89 | $456.46 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.73 / $316.92 / $500.02
| Professional | | $172.73 | $316.92 | $500.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.52 / $572.41 / $806.47
| Professional | | $269.52 | $572.41 | $806.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.28 / $890.28 / $890.28
| Facility | | $890.28 | $890.28 | $890.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.57 / $650.96 / $650.96
| Professional | | $475.57 | $650.96 | $650.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,067.14 / $3,649.00 / $26,542.00
| Facility | | $1,067.14 | $3,649.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.81 / $630.66 / $1,985.92
| Professional | | $290.81 | $630.66 | $1,985.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.04 / $407.38 / $827.30
| Professional | | $276.04 | $407.38 | $827.30 |