- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.24 / $2,240.00 / $7,629.00
| Facility | | $292.24 | $2,240.00 | $7,629.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.19 / $227.06 / $345.58
| Professional | | $158.19 | $227.06 | $345.58 |
- 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
- $248.42 / $257.80 / $422.22
| Professional | | $248.42 | $257.80 | $422.22 |
- 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
- $142.71 / $230.84 / $386.43
| Professional | | $142.71 | $230.84 | $386.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.98 / $305.98 / $394.57
| Professional | | $305.98 | $305.98 | $394.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $617.00 / $2,371.00 / $8,017.00
| Facility | | $617.00 | $2,371.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.79 / $258.25 / $1,426.00
| Professional | | $159.79 | $258.25 | $1,426.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.80 / $310.80 / $351.20
| Professional | | $310.80 | $310.80 | $351.20 |
- 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
- $148.60 / $224.66 / $375.54
| Professional | | $148.60 | $224.66 | $375.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.63 / $158.91 / $368.39
| Facility | | $157.63 | $158.91 | $368.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.63 / $248.85 / $368.39
| Professional | | $157.63 | $248.85 | $368.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.00 / $674.00 / $4,300.00
| Facility | | $144.00 | $674.00 | $4,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.74 / $294.51 / $489.78
| Professional | | $211.74 | $294.51 | $489.78 |