- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $217.59 / $2,079.00 / $3,685.00
| Facility | | $217.59 | $2,079.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.03 / $217.59 / $352.59
| Professional | | $168.03 | $217.59 | $352.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.11 / $1,483.60 / $7,161.00
| Facility | | $416.11 | $1,483.60 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.93 / $408.18 / $1,648.34
| Professional | | $188.93 | $408.18 | $1,648.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.83 / $268.35 / $479.06
| Facility | | $208.83 | $268.35 | $479.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.47 / $411.38 / $955.81
| Professional | | $266.47 | $411.38 | $955.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.42 / $335.92 / $569.82
| Professional | | $221.42 | $335.92 | $569.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.08 / $380.78 / $6,679.00
| Facility | | $181.08 | $380.78 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.70 / $293.99 / $402.55
| Professional | | $242.70 | $293.99 | $402.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.78 / $461.13 / $662.22
| Professional | | $221.78 | $461.13 | $662.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,601.82 / $1,601.82 / $2,098.52
| Facility | | $1,601.82 | $1,601.82 | $2,098.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.52 / $721.17 / $752.54
| Professional | | $585.52 | $721.17 | $752.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,078.00 / $12,000.00
| Facility | | $1,106.00 | $2,078.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.11 / $507.03 / $1,648.34
| Professional | | $258.11 | $507.03 | $1,648.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.00 / $2,408.00 / $7,161.00
| Facility | | $950.00 | $2,408.00 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.12 / $392.90 / $658.96
| Professional | | $238.12 | $392.90 | $658.96 |