- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.00 / $2,094.00 / $3,685.00
| Facility | | $988.00 | $2,094.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.24 / $232.85 / $309.07
| Professional | | $193.24 | $232.85 | $309.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.87 / $4,983.00 / $10,138.40
| Facility | | $471.87 | $4,983.00 | $10,138.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.79 / $267.79 / $1,447.08
| Professional | | $163.79 | $267.79 | $1,447.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.37 / $452.37 / $2,160.52
| Professional | | $452.37 | $452.37 | $2,160.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,082.51 / $2,082.51 / $2,082.51
| Facility | | $2,082.51 | $2,082.51 | $2,082.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.04 / $340.85 / $619.71
| Professional | | $190.04 | $340.85 | $619.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.84 / $411.40 / $6,679.00
| Facility | | $194.84 | $411.40 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.08 / $262.27 / $362.03
| Professional | | $211.08 | $262.27 | $362.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.11 / $473.51 / $5,944.58
| Professional | | $235.11 | $473.51 | $5,944.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.86 / $147.86 / $147.86
| Professional | | $147.86 | $147.86 | $147.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,672.00 / $5,572.00 / $12,000.00
| Facility | | $1,672.00 | $5,572.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.39 / $274.80 / $1,447.08
| Professional | | $191.39 | $274.80 | $1,447.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,402.00 / $8,810.00
| Facility | | $2,155.00 | $4,402.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.66 / $255.99 / $538.79
| Professional | | $188.66 | $255.99 | $538.79 |