- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $462.67 / $2,079.00 / $3,625.00
| Facility | | $462.67 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.27 / $462.67 / $1,042.60
| Professional | | $101.27 | $462.67 | $1,042.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.79 / $736.00 / $2,796.00
| Facility | | $154.79 | $736.00 | $2,796.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.27 / $746.58 / $1,934.92
| Professional | | $148.27 | $746.58 | $1,934.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.05 / $208.07 / $408.13
| Facility | | $160.05 | $208.07 | $408.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.31 / $518.91 / $931.41
| Professional | | $230.31 | $518.91 | $931.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.86 / $572.44 / $1,543.79
| Professional | | $217.86 | $572.44 | $1,543.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.15 / $218.88 / $6,679.00
| Facility | | $141.15 | $218.88 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.76 / $621.15 / $1,110.58
| Professional | | $522.76 | $621.15 | $1,110.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.72 / $467.06 / $1,155.84
| Professional | | $175.72 | $467.06 | $1,155.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $567.02 / $567.02 / $567.02
| Facility | | $567.02 | $567.02 | $567.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.18 / $266.00 / $857.57
| Professional | | $222.18 | $266.00 | $857.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,078.00 / $3,445.00
| Facility | | $55.00 | $1,078.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $699.14 / $1,220.89 / $3,038.48
| Professional | | $699.14 | $1,220.89 | $3,038.48 |
- 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
- $662.33 / $986.49 / $1,934.92
| Professional | | $662.33 | $986.49 | $1,934.92 |