- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $62.01 / $2,410.00 / $3,469.00
| Facility | | $62.01 | $2,410.00 | $3,469.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.02 / $289.72 / $891.17
| Professional | | $83.02 | $289.72 | $891.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.36 / $1,689.00 / $4,689.00
| Facility | | $215.36 | $1,689.00 | $4,689.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.10 / $979.58 / $4,911.84
| Professional | | $113.10 | $979.58 | $4,911.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.97 / $134.47 / $243.10
| Facility | | $105.97 | $134.47 | $243.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.27 / $859.36 / $1,542.47
| Professional | | $143.27 | $859.36 | $1,542.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.83 / $340.25 / $1,657.71
| Professional | | $107.83 | $340.25 | $1,657.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.94 / $725.16 / $6,679.00
| Facility | | $92.94 | $725.16 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $799.15 / $1,014.93 / $1,490.89
| Professional | | $799.15 | $1,014.93 | $1,490.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.13 / $714.08 / $1,872.56
| Professional | | $119.13 | $714.08 | $1,872.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,272.65 / $2,272.65 / $2,637.69
| Facility | | $2,272.65 | $2,272.65 | $2,637.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.62 / $144.18 / $147.76
| Professional | | $140.62 | $144.18 | $147.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $2,329.00 / $4,952.00
| Facility | | $822.00 | $2,329.00 | $4,952.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.60 / $1,425.52 / $4,911.84
| Professional | | $687.60 | $1,425.52 | $4,911.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.59 / $955.72 / $1,812.07
| Professional | | $517.59 | $955.72 | $1,812.07 |