- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $205.51 / $2,240.00 / $7,629.00
| Facility | | $205.51 | $2,240.00 | $7,629.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.01 / $181.96 / $372.89
| Professional | | $112.01 | $181.96 | $372.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,299.82 / $2,746.00 / $13,822.74
| Facility | | $2,299.82 | $2,746.00 | $13,822.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.59 / $222.68 / $369.26
| Professional | | $214.59 | $222.68 | $369.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.60 / $202.44 / $383.47
| Professional | | $124.60 | $202.44 | $383.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.58 / $335.03 / $346.37
| Professional | | $260.58 | $335.03 | $346.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,743.78 / $2,743.78 / $2,743.78
| Facility | | $2,743.78 | $2,743.78 | $2,743.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $617.00 / $2,371.00 / $8,017.00
| Facility | | $617.00 | $2,371.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.28 / $205.22 / $1,023.00
| Professional | | $113.28 | $205.22 | $1,023.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.50 / $196.50 / $207.50
| Professional | | $196.50 | $196.50 | $207.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.54 / $220.54 / $220.54
| Facility | | $220.54 | $220.54 | $220.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.04 / $202.86 / $389.90
| Professional | | $127.04 | $202.86 | $389.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $127.37 / $166.25 / $241.92
| Facility | | $127.37 | $166.25 | $241.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.37 / $211.82 / $232.42
| Professional | | $127.37 | $211.82 | $232.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.00 / $674.00 / $4,300.00
| Facility | | $144.00 | $674.00 | $4,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.73 / $231.30 / $393.77
| Professional | | $178.73 | $231.30 | $393.77 |