- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.75 / $2,067.00 / $3,685.00
| Facility | | $144.75 | $2,067.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.49 / $169.64 / $448.75
| Professional | | $123.49 | $169.64 | $448.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.32 / $1,339.09 / $3,804.00
| Facility | | $346.32 | $1,339.09 | $3,804.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.13 / $352.68 / $1,313.04
| Professional | | $157.13 | $352.68 | $1,313.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $180.55 / $234.72 / $414.18
| Facility | | $180.55 | $234.72 | $414.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.38 / $324.07 / $461.34
| Professional | | $230.38 | $324.07 | $461.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.75 / $373.04 / $691.35
| Professional | | $245.75 | $373.04 | $691.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.59 / $300.00 / $8,090.00
| Facility | | $153.59 | $300.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.35 / $262.02 / $468.46
| Professional | | $207.35 | $262.02 | $468.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.28 / $398.46 / $567.60
| Professional | | $191.28 | $398.46 | $567.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $768.89 / $768.89 / $931.69
| Facility | | $768.89 | $768.89 | $931.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.12 / $244.18 / $341.66
| Professional | | $238.12 | $244.18 | $341.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,878.00 / $7,161.00
| Facility | | $55.00 | $1,878.00 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.67 / $434.50 / $1,313.04
| Professional | | $228.67 | $434.50 | $1,313.04 |
- 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
- $212.69 / $289.62 / $561.73
| Professional | | $212.69 | $289.62 | $561.73 |