- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.08 / $2,618.00 / $3,625.00
| Facility | | $155.08 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.82 / $158.58 / $331.69
| Professional | | $94.82 | $158.58 | $331.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.55 / $1,251.81 / $7,161.00
| Facility | | $311.55 | $1,251.81 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.08 / $296.98 / $923.76
| Professional | | $141.08 | $296.98 | $923.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.21 / $196.57 / $346.88
| Facility | | $151.21 | $196.57 | $346.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.19 / $314.92 / $537.80
| Professional | | $205.19 | $314.92 | $537.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.69 / $265.45 / $544.46
| Professional | | $142.69 | $265.45 | $544.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.82 / $214.32 / $6,679.00
| Facility | | $129.82 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.34 / $286.76 / $396.65
| Professional | | $226.34 | $286.76 | $396.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.88 / $332.59 / $599.42
| Professional | | $156.88 | $332.59 | $599.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.98 / $320.98 / $320.98
| Professional | | $320.98 | $320.98 | $320.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $873.48 / $2,078.00 / $11,500.00
| Facility | | $873.48 | $2,078.00 | $11,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.98 / $380.14 / $1,462.96
| Professional | | $203.98 | $380.14 | $1,462.96 |
- 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
- $165.62 / $284.58 / $618.83
| Professional | | $165.62 | $284.58 | $618.83 |