- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.13 / $2,547.00 / $3,625.00
| Facility | | $105.13 | $2,547.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.86 / $137.37 / $362.46
| Professional | | $82.86 | $137.37 | $362.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $266.64 / $1,251.81 / $7,161.00
| Facility | | $266.64 | $1,251.81 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.28 / $217.31 / $785.44
| Professional | | $112.28 | $217.31 | $785.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.38 / $170.79 / $301.39
| Facility | | $131.38 | $170.79 | $301.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.68 / $235.81 / $335.70
| Professional | | $149.68 | $235.81 | $335.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.94 / $198.48 / $418.63
| Professional | | $119.94 | $198.48 | $418.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.55 / $214.32 / $6,679.00
| Facility | | $111.55 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.13 / $201.63 / $279.64
| Professional | | $159.13 | $201.63 | $279.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.53 / $279.42 / $433.97
| Professional | | $133.53 | $279.42 | $433.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $477.94 / $6,231.63
| Facility | | $144.54 | $477.94 | $6,231.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.38 / $208.61 / $260.45
| Professional | | $98.38 | $208.61 | $260.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $745.08 / $2,078.00 / $11,500.00
| Facility | | $745.08 | $2,078.00 | $11,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.16 / $265.60 / $1,026.40
| Professional | | $151.16 | $265.60 | $1,026.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,408.00 / $5,683.00
| Facility | | $1,106.00 | $2,408.00 | $5,683.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.35 / $202.57 / $398.40
| Professional | | $130.35 | $202.57 | $398.40 |