- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $135.87 / $1,886.00 / $3,625.00
| Facility | | $135.87 | $1,886.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.68 / $197.75 / $341.11
| Professional | | $125.68 | $197.75 | $341.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.65 / $1,089.00 / $5,047.31
| Facility | | $138.65 | $1,089.00 | $5,047.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.12 / $365.29 / $1,632.56
| Professional | | $174.12 | $365.29 | $1,632.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.63 / $200.00 / $357.04
| Facility | | $155.63 | $200.00 | $357.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.23 / $1,620.25 / $1,620.25
| Professional | | $255.23 | $1,620.25 | $1,620.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.23 / $362.90 / $500.00
| Facility | | $288.23 | $362.90 | $500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.03 / $318.41 / $618.74
| Professional | | $163.03 | $318.41 | $618.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.12 / $377.00 / $6,679.00
| Facility | | $133.12 | $377.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.58 / $342.63 / $489.26
| Professional | | $263.58 | $342.63 | $489.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.46 / $355.64 / $617.85
| Professional | | $189.46 | $355.64 | $617.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.07 / $412.07 / $412.07
| Professional | | $412.07 | $412.07 | $412.07 |
- 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
- $232.92 / $550.16 / $1,632.56
| Professional | | $232.92 | $550.16 | $1,632.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $669.00 / $2,338.00 / $4,952.00
| Facility | | $669.00 | $2,338.00 | $4,952.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.23 / $337.35 / $763.80
| Professional | | $214.23 | $337.35 | $763.80 |