- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.22 / $2,067.00 / $3,625.00
| Facility | | $176.22 | $2,067.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.47 / $204.20 / $565.37
| Professional | | $112.47 | $204.20 | $565.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $364.23 / $1,251.81 / $7,161.00
| Facility | | $364.23 | $1,251.81 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.11 / $336.52 / $1,082.40
| Professional | | $164.11 | $336.52 | $1,082.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.19 / $229.05 / $404.18
| Facility | | $176.19 | $229.05 | $404.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.62 / $365.89 / $574.91
| Professional | | $236.62 | $365.89 | $574.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.25 / $307.33 / $616.13
| Professional | | $166.25 | $307.33 | $616.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.63 / $240.95 / $6,679.00
| Facility | | $151.63 | $240.95 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.15 / $321.80 / $444.21
| Professional | | $254.15 | $321.80 | $444.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.50 / $388.47 / $674.23
| Professional | | $183.50 | $388.47 | $674.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.89 / $2,242.02 / $4,320.31
| Facility | | $358.89 | $2,242.02 | $4,320.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.62 / $212.99 / $276.00
| Professional | | $167.62 | $212.99 | $276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $754.16 / $2,078.00 / $11,500.00
| Facility | | $754.16 | $2,078.00 | $11,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.99 / $432.71 / $1,647.84
| Professional | | $225.99 | $432.71 | $1,647.84 |
- 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
- $176.82 / $320.27 / $662.02
| Professional | | $176.82 | $320.27 | $662.02 |