- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.21 / $2,159.00 / $3,685.00
| Facility | | $241.21 | $2,159.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.25 / $241.21 / $757.00
| Professional | | $149.25 | $241.21 | $757.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $312.77 / $2,575.00 / $5,714.00
| Facility | | $312.77 | $2,575.00 | $5,714.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.33 / $382.26 / $2,203.34
| Professional | | $163.33 | $382.26 | $2,203.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.83 / $209.08 / $368.94
| Facility | | $160.83 | $209.08 | $368.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.02 / $321.02 / $563.45
| Professional | | $321.02 | $321.02 | $563.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.81 / $386.55 / $762.43
| Professional | | $214.81 | $386.55 | $762.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.91 / $219.95 / $6,679.00
| Facility | | $140.91 | $219.95 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.66 / $284.38 / $437.17
| Professional | | $147.66 | $284.38 | $437.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.75 / $380.71 / $642.91
| Professional | | $176.75 | $380.71 | $642.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.43 / $2,432.73 / $4,463.91
| Facility | | $0.43 | $2,432.73 | $4,463.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.74 / $226.74 / $226.74
| Professional | | $226.74 | $226.74 | $226.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $9,039.00
| Facility | | $55.00 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.33 / $604.55 / $2,203.34
| Professional | | $320.33 | $604.55 | $2,203.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.58 / $394.96 / $861.38
| Professional | | $289.58 | $394.96 | $861.38 |