- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.78 / $2,240.00 / $7,629.00
| Facility | | $223.78 | $2,240.00 | $7,629.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.49 / $211.26 / $308.58
| Professional | | $143.49 | $211.26 | $308.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,083.51 / $1,395.00 / $12,759.45
| Facility | | $1,083.51 | $1,395.00 | $12,759.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.84 / $249.93 / $249.93
| Professional | | $240.84 | $249.93 | $249.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.65 / $236.16 / $414.65
| Professional | | $152.65 | $236.16 | $414.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.47 / $369.60 / $380.45
| Professional | | $287.47 | $369.60 | $380.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.73 / $234.73 / $234.73
| Professional | | $234.73 | $234.73 | $234.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.00 / $2,371.00 / $8,017.00
| Facility | | $594.00 | $2,371.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.16 / $214.49 / $900.83
| Professional | | $149.16 | $214.49 | $900.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.24 / $230.00 / $337.07
| Professional | | $158.24 | $230.00 | $337.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $284.56 / $284.56 / $284.56
| Facility | | $284.56 | $284.56 | $284.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.24 / $238.57 / $432.82
| Professional | | $158.24 | $238.57 | $432.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.88 / $179.60 / $242.24
| Facility | | $162.88 | $179.60 | $242.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.85 / $233.33 / $253.97
| Professional | | $162.85 | $233.33 | $253.97 |
- 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
- $208.89 / $264.12 / $453.04
| Professional | | $208.89 | $264.12 | $453.04 |