- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.54 / $2,240.00 / $7,629.00
| Facility | | $332.54 | $2,240.00 | $7,629.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.64 / $255.30 / $396.16
| Professional | | $125.64 | $255.30 | $396.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,299.82 / $2,746.00 / $13,822.74
| Facility | | $2,299.82 | $2,746.00 | $13,822.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.23 / $290.81 / $502.72
| Professional | | $280.23 | $290.81 | $502.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.00 / $358.00 / $358.00
| Facility | | $358.00 | $358.00 | $358.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.48 / $251.60 / $446.01
| Professional | | $119.48 | $251.60 | $446.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.41 / $349.41 / $450.57
| Professional | | $349.41 | $349.41 | $450.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.00 / $2,371.00 / $8,017.00
| Facility | | $594.00 | $2,371.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.32 / $288.77 / $1,426.00
| Professional | | $127.32 | $288.77 | $1,426.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.60 / $375.60 / $375.60
| Professional | | $375.60 | $375.60 | $375.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.00 / $358.00 / $358.00
| Facility | | $358.00 | $358.00 | $358.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.17 / $248.98 / $396.87
| Professional | | $119.17 | $248.98 | $396.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.86 / $179.08 / $466.47
| Facility | | $125.86 | $179.08 | $466.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.20 / $280.95 / $466.47
| Professional | | $125.20 | $280.95 | $466.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.00 / $2,391.00 / $6,000.00
| Facility | | $814.00 | $2,391.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.98 / $337.35 / $562.17
| Professional | | $254.98 | $337.35 | $562.17 |