- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.96 / $2,605.00 / $7,629.00
| Facility | | $225.96 | $2,605.00 | $7,629.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.61 / $198.04 / $408.19
| Professional | | $159.61 | $198.04 | $408.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.76 / $163.76 / $448.44
| Professional | | $163.76 | $163.76 | $448.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,450.00 / $5,951.00 / $8,887.00
| Facility | | $2,450.00 | $5,951.00 | $8,887.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.57 / $251.72 / $346.08
| Professional | | $242.57 | $251.72 | $346.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.96 / $251.72 / $432.38
| Professional | | $184.96 | $251.72 | $432.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.39 / $388.64 / $391.11
| Professional | | $292.39 | $388.64 | $391.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $878.30 / $6,715.99 / $14,623.00
| Facility | | $878.30 | $6,715.99 | $14,623.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.58 / $2,605.00 / $8,017.00
| Facility | | $308.58 | $2,605.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.73 / $247.81 / $500.44
| Professional | | $169.73 | $247.81 | $500.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $261.20 / $657.10
| Professional | | $3.00 | $261.20 | $657.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.23 / $257.56 / $437.07
| Professional | | $187.23 | $257.56 | $437.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.68 / $187.36 / $242.85
| Facility | | $184.68 | $187.36 | $242.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.68 / $212.99 / $259.48
| Professional | | $184.68 | $212.99 | $259.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,334.00 / $2,824.00 / $5,678.00
| Facility | | $1,334.00 | $2,824.00 | $5,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.39 / $264.07 / $438.76
| Professional | | $194.39 | $264.07 | $438.76 |