- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.65 / $2,067.00 / $3,625.00
| Facility | | $136.65 | $2,067.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.68 / $173.13 / $586.54
| Professional | | $118.68 | $173.13 | $586.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $334.71 / $3,315.28 / $10,821.00
| Facility | | $334.71 | $3,315.28 | $10,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.80 / $322.92 / $1,371.84
| Professional | | $150.80 | $322.92 | $1,371.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.31 / $208.40 / $367.75
| Facility | | $160.31 | $208.40 | $367.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.23 / $333.96 / $504.94
| Professional | | $204.23 | $333.96 | $504.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.24 / $324.52 / $555.53
| Professional | | $173.24 | $324.52 | $555.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $137.04 / $219.23 / $6,679.00
| Facility | | $137.04 | $219.23 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.40 / $220.72 / $348.25
| Professional | | $121.40 | $220.72 | $348.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.62 / $363.69 / $521.05
| Professional | | $169.62 | $363.69 | $521.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,850.43 / $1,850.43 / $1,859.98
| Facility | | $1,850.43 | $1,850.43 | $1,859.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.22 / $265.80 / $316.00
| Professional | | $212.22 | $265.80 | $316.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $685.66 / $3,649.00 / $11,500.00
| Facility | | $685.66 | $3,649.00 | $11,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.97 / $442.58 / $1,371.84
| Professional | | $190.97 | $442.58 | $1,371.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.15 / $267.36 / $586.52
| Professional | | $174.15 | $267.36 | $586.52 |