- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.00 / $2,096.25 / $3,693.00
| Facility | | $988.00 | $2,096.25 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.31 / $97.58 / $259.49
| Professional | | $88.31 | $97.58 | $259.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.55 / $2,871.43 / $10,821.00
| Facility | | $238.55 | $2,871.43 | $10,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.18 / $189.85 / $1,509.00
| Professional | | $95.18 | $189.85 | $1,509.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.15 / $186.15 / $186.15
| Professional | | $186.15 | $186.15 | $186.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.80 / $203.44 / $373.76
| Professional | | $137.80 | $203.44 | $373.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.31 / $300.00 / $6,679.00
| Facility | | $97.31 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.47 / $138.33 / $247.32
| Professional | | $109.47 | $138.33 | $247.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.56 / $234.46 / $312.47
| Professional | | $117.56 | $234.46 | $312.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,928.58 / $1,928.58 / $5,267.55
| Facility | | $1,928.58 | $1,928.58 | $5,267.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.41 / $115.41 / $115.41
| Professional | | $115.41 | $115.41 | $115.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $3,672.00 / $12,000.00
| Facility | | $822.00 | $3,672.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.06 / $213.06 / $1,509.00
| Professional | | $117.06 | $213.06 | $1,509.00 |
- 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
- $111.31 / $172.73 / $386.84
| Professional | | $111.31 | $172.73 | $386.84 |