- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $615.73 / $2,822.00 / $6,107.00
| Facility | | $615.73 | $2,822.00 | $6,107.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.95 / $266.77 / $978.00
| Professional | | $168.95 | $266.77 | $978.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $543.71 / $3,764.00 / $12,379.00
| Facility | | $543.71 | $3,764.00 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.87 / $501.25 / $2,500.00
| Professional | | $217.87 | $501.25 | $2,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.70 / $472.73 / $730.24
| Professional | | $292.70 | $472.73 | $730.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.76 / $471.13 / $839.65
| Professional | | $263.76 | $471.13 | $839.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.30 / $471.00 / $6,679.00
| Facility | | $222.30 | $471.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.13 / $281.99 / $454.62
| Professional | | $153.13 | $281.99 | $454.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.43 / $565.52 / $780.71
| Professional | | $274.43 | $565.52 | $780.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,538.81 / $2,538.81 / $4,463.91
| Facility | | $2,538.81 | $2,538.81 | $4,463.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.22 / $363.21 / $440.97
| Professional | | $354.22 | $363.21 | $440.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,250.05 / $4,249.00 / $26,542.00
| Facility | | $1,250.05 | $4,249.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.08 / $631.59 / $2,500.00
| Professional | | $274.08 | $631.59 | $2,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,700.00 / $4,249.00 / $9,821.00
| Facility | | $1,700.00 | $4,249.00 | $9,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.45 / $409.78 / $880.38
| Professional | | $270.45 | $409.78 | $880.38 |