- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $156.51 / $2,618.00 / $3,625.00
| Facility | | $156.51 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.13 / $156.51 / $227.71
| Professional | | $143.13 | $156.51 | $227.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.84 / $1,695.92 / $6,482.70
| Facility | | $166.84 | $1,695.92 | $6,482.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.24 / $273.01 / $1,101.11
| Professional | | $160.24 | $273.01 | $1,101.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.04 / $2,406.48 / $2,406.48
| Professional | | $540.04 | $2,406.48 | $2,406.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $748.00 / $2,499.59
| Facility | | $680.00 | $748.00 | $2,499.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.44 / $285.20 / $531.16
| Professional | | $172.44 | $285.20 | $531.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.75 / $300.00 / $6,679.00
| Facility | | $148.75 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.69 / $213.38 / $308.22
| Professional | | $170.69 | $213.38 | $308.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.96 / $367.08 / $463.15
| Professional | | $185.96 | $367.08 | $463.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,866.13 / $6,482.70
| Facility | | $55.00 | $1,866.13 | $6,482.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.48 / $277.81 / $1,101.11
| Professional | | $172.48 | $277.81 | $1,101.11 |
- 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
- $161.07 / $244.42 / $559.34
| Professional | | $161.07 | $244.42 | $559.34 |