- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $221.80 / $2,240.00 / $7,629.00
| Facility | | $221.80 | $2,240.00 | $7,629.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.59 / $209.64 / $306.95
| Professional | | $145.59 | $209.64 | $306.95 |
- 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
- $239.38 / $248.41 / $248.41
| Professional | | $239.38 | $248.41 | $248.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.69 / $235.14 / $421.65
| Professional | | $155.69 | $235.14 | $421.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.32 / $366.84 / $377.52
| Professional | | $285.32 | $366.84 | $377.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.70 / $233.46 / $241.92
| Professional | | $220.70 | $233.46 | $241.92 |
- 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
- $151.28 / $213.67 / $658.74
| Professional | | $151.28 | $213.67 | $658.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.46 / $230.70 / $334.71
| Professional | | $160.46 | $230.70 | $334.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.58 / $288.58 / $288.58
| Facility | | $288.58 | $288.58 | $288.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.46 / $237.12 / $435.22
| Professional | | $160.46 | $237.12 | $435.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.21 / $177.09 / $236.52
| Facility | | $165.21 | $177.09 | $236.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.17 / $231.52 / $251.86
| Professional | | $165.17 | $231.52 | $251.86 |
- 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
- $198.58 / $255.53 / $463.31
| Professional | | $198.58 | $255.53 | $463.31 |