- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.68 / $2,079.00 / $3,685.00
| Facility | | $149.68 | $2,079.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.69 / $165.93 / $389.10
| Professional | | $143.69 | $165.93 | $389.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.46 / $3,764.00 / $12,000.00
| Facility | | $384.46 | $3,764.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.57 / $342.82 / $1,311.92
| Professional | | $156.57 | $342.82 | $1,311.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.42 / $239.38 / $423.06
| Facility | | $184.42 | $239.38 | $423.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.95 / $357.43 / $583.07
| Professional | | $234.95 | $357.43 | $583.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.62 / $334.10 / $662.07
| Professional | | $199.62 | $334.10 | $662.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.27 / $336.28 / $6,679.00
| Facility | | $158.27 | $336.28 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.03 / $209.17 / $337.22
| Professional | | $114.03 | $209.17 | $337.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.69 / $399.19 / $562.60
| Professional | | $191.69 | $399.19 | $562.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,449.12 / $1,449.12 / $1,449.12
| Facility | | $1,449.12 | $1,449.12 | $1,449.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.41 / $455.41 / $455.41
| Professional | | $455.41 | $455.41 | $455.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $788.17 / $4,249.00 / $12,000.00
| Facility | | $788.17 | $4,249.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.41 / $422.00 / $1,311.92
| Professional | | $204.41 | $422.00 | $1,311.92 |
- 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
- $195.40 / $257.58 / $520.80
| Professional | | $195.40 | $257.58 | $520.80 |