- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $113.91 / $2,410.00 / $3,469.00
| Facility | | $113.91 | $2,410.00 | $3,469.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.75 / $168.34 / $293.12
| Professional | | $105.75 | $168.34 | $293.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.30 / $1,089.00 / $5,047.31
| Facility | | $104.30 | $1,089.00 | $5,047.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.58 / $300.04 / $1,347.76
| Professional | | $146.58 | $300.04 | $1,347.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.25 / $169.94 / $303.12
| Facility | | $132.25 | $169.94 | $303.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.88 / $1,620.25 / $1,620.25
| Professional | | $216.88 | $1,620.25 | $1,620.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.46 / $285.12 / $652.29
| Facility | | $226.46 | $285.12 | $652.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.72 / $265.08 / $510.80
| Professional | | $137.72 | $265.08 | $510.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $113.57 / $506.00 / $6,679.00
| Facility | | $113.57 | $506.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.76 / $280.91 / $402.36
| Professional | | $216.76 | $280.91 | $402.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.91 / $303.94 / $508.98
| Professional | | $161.91 | $303.94 | $508.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.80 / $345.80 / $345.80
| Professional | | $345.80 | $345.80 | $345.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,640.00 / $4,755.00
| Facility | | $55.00 | $1,640.00 | $4,755.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.83 / $449.23 / $1,347.76
| Professional | | $194.83 | $449.23 | $1,347.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $3,133.00 / $8,425.00
| Facility | | $822.00 | $3,133.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.49 / $281.35 / $573.51
| Professional | | $178.49 | $281.35 | $573.51 |