- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.55 / $9,639.00 / $20,509.00
| Facility | | $193.55 | $9,639.00 | $20,509.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.35 / $193.55 / $939.38
| Professional | | $179.35 | $193.55 | $939.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,537.00 / $10,983.00 / $22,417.00
| Facility | | $3,537.00 | $10,983.00 | $22,417.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.70 / $398.74 / $697.75
| Professional | | $288.70 | $398.74 | $697.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.50 / $100.00 / $1,693.95
| Facility | | $63.50 | $100.00 | $1,693.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.95 / $271.35 / $587.23
| Professional | | $189.95 | $271.35 | $587.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.60 / $235.13 / $593.44
| Professional | | $190.60 | $235.13 | $593.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.52 / $184.76 / $221.71
| Professional | | $135.52 | $184.76 | $221.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.98 / $215.45 / $396.00
| Professional | | $167.98 | $215.45 | $396.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,505.16 / $1,852.92
| Facility | | $55.00 | $1,505.16 | $1,852.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,267.59 / $1,295.83 / $1,537.80
| Professional | | $1,267.59 | $1,295.83 | $1,537.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.68 / $218.37 / $297.63
| Facility | | $176.68 | $218.37 | $297.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.94 / $235.13 / $545.27
| Professional | | $188.94 | $235.13 | $545.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.86 / $582.86 / $582.86
| Professional | | $582.86 | $582.86 | $582.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,047.00 / $5,319.00 / $20,279.00
| Facility | | $2,047.00 | $5,319.00 | $20,279.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.44 / $237.05 / $513.27
| Professional | | $155.44 | $237.05 | $513.27 |