- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.44 / $2,079.00 / $3,693.00
| Facility | | $219.44 | $2,079.00 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.36 / $219.44 / $556.29
| Professional | | $133.36 | $219.44 | $556.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $282.02 / $2,329.00 / $5,803.32
| Facility | | $282.02 | $2,329.00 | $5,803.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.59 / $347.12 / $1,545.84
| Professional | | $140.59 | $347.12 | $1,545.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.36 / $192.87 / $340.95
| Facility | | $148.36 | $192.87 | $340.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.30 / $243.30 / $433.43
| Professional | | $243.30 | $243.30 | $433.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.72 / $366.79 / $698.77
| Professional | | $190.72 | $366.79 | $698.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.50 / $214.32 / $6,679.00
| Facility | | $126.50 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.82 / $315.68 / $524.37
| Professional | | $249.82 | $315.68 | $524.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.76 / $335.50 / $585.62
| Professional | | $155.76 | $335.50 | $585.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,813.34 / $1,813.34 / $1,813.34
| Facility | | $1,813.34 | $1,813.34 | $1,813.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.98 / $373.98 / $373.98
| Professional | | $373.98 | $373.98 | $373.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,376.00 / $8,498.00
| Facility | | $55.00 | $2,376.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.58 / $663.03 / $1,545.84
| Professional | | $249.58 | $663.03 | $1,545.84 |
- 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
- $224.97 / $337.34 / $809.36
| Professional | | $224.97 | $337.34 | $809.36 |