- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $201.24 / $2,663.12 / $3,625.00
| Facility | | $201.24 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.39 / $225.57 / $457.99
| Professional | | $123.39 | $225.57 | $457.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $386.22 / $2,948.45 / $10,821.00
| Facility | | $386.22 | $2,948.45 | $10,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.12 / $411.65 / $1,796.00
| Professional | | $193.12 | $411.65 | $1,796.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $185.62 / $241.31 / $425.81
| Facility | | $185.62 | $241.31 | $425.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.39 / $304.39 / $491.05
| Professional | | $304.39 | $304.39 | $491.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.65 / $435.12 / $795.06
| Professional | | $235.65 | $435.12 | $795.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.15 / $338.46 / $6,679.00
| Facility | | $161.15 | $338.46 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.83 / $362.46 / $648.04
| Professional | | $286.83 | $362.46 | $648.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.95 / $434.98 / $751.52
| Professional | | $201.95 | $434.98 | $751.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,673.20 / $2,673.20 / $2,673.20
| Facility | | $2,673.20 | $2,673.20 | $2,673.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.05 / $219.05 / $219.05
| Professional | | $219.05 | $219.05 | $219.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,274.63 / $3,649.00 / $12,000.00
| Facility | | $1,274.63 | $3,649.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.63 / $625.72 / $1,796.00
| Professional | | $310.63 | $625.72 | $1,796.00 |
- 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
- $292.48 / $389.11 / $868.70
| Professional | | $292.48 | $389.11 | $868.70 |