- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.21 / $2,079.00 / $3,685.00
| Facility | | $177.21 | $2,079.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.46 / $190.65 / $392.33
| Professional | | $113.46 | $190.65 | $392.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.55 / $1,251.81 / $7,161.00
| Facility | | $366.55 | $1,251.81 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.75 / $337.84 / $1,089.83
| Professional | | $164.75 | $337.84 | $1,089.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.62 / $230.91 / $407.46
| Facility | | $177.62 | $230.91 | $407.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.55 / $351.46 / $577.88
| Professional | | $211.55 | $351.46 | $577.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.60 / $308.22 / $620.40
| Professional | | $167.60 | $308.22 | $620.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.85 / $242.90 / $6,679.00
| Facility | | $152.85 | $242.90 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.47 / $323.47 / $446.51
| Professional | | $255.47 | $323.47 | $446.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.14 / $391.94 / $678.15
| Professional | | $185.14 | $391.94 | $678.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $363.08
| Professional | | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $759.72 / $2,078.00 / $11,500.00
| Facility | | $759.72 | $2,078.00 | $11,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.76 / $434.68 / $1,655.36
| Professional | | $224.76 | $434.68 | $1,655.36 |
- 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
- $176.85 / $321.64 / $628.75
| Professional | | $176.85 | $321.64 | $628.75 |