- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $360.80 / $2,079.00 / $3,625.00
| Facility | | $360.80 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.40 / $360.80 / $794.78
| Professional | | $111.40 | $360.80 | $794.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.96 / $712.50 / $2,733.00
| Facility | | $229.96 | $712.50 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.66 / $873.05 / $4,661.29
| Professional | | $130.66 | $873.05 | $4,661.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.02 / $149.77 / $270.74
| Facility | | $118.02 | $149.77 | $270.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.15 / $629.35 / $1,153.84
| Professional | | $160.15 | $629.35 | $1,153.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.94 / $299.61 / $1,332.71
| Professional | | $134.94 | $299.61 | $1,332.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.04 / $300.00 / $6,679.00
| Facility | | $104.04 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.20 / $774.10 / $1,335.68
| Professional | | $591.20 | $774.10 | $1,335.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.84 / $529.20 / $1,430.71
| Professional | | $148.84 | $529.20 | $1,430.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.81 / $160.81 / $160.81
| Facility | | $160.81 | $160.81 | $160.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.14 / $106.77 / $376.67
| Professional | | $83.14 | $106.77 | $376.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $953.00 / $2,796.00
| Facility | | $308.00 | $953.00 | $2,796.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $542.79 / $1,399.02 / $4,661.29
| Professional | | $542.79 | $1,399.02 | $4,661.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.90 / $968.55 / $1,880.25
| Professional | | $214.90 | $968.55 | $1,880.25 |