- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.66 / $2,663.12 / $3,693.00
| Facility | | $182.66 | $2,663.12 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.69 / $195.94 / $395.49
| Professional | | $162.69 | $195.94 | $395.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.53 / $3,764.00 / $12,379.00
| Facility | | $428.53 | $3,764.00 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.05 / $365.59 / $2,741.00
| Professional | | $179.05 | $365.59 | $2,741.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.07 / $265.29 / $468.14
| Facility | | $204.07 | $265.29 | $468.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.99 / $407.32 / $733.32
| Professional | | $259.99 | $407.32 | $733.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.96 / $394.28 / $740.61
| Professional | | $221.96 | $394.28 | $740.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.84 / $372.10 / $6,679.00
| Facility | | $175.84 | $372.10 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.41 / $262.80 / $414.64
| Professional | | $143.41 | $262.80 | $414.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.58 / $467.51 / $657.22
| Professional | | $219.58 | $467.51 | $657.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,103.34 / $3,103.34 / $3,103.34
| Facility | | $3,103.34 | $3,103.34 | $3,103.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.89 / $267.89 / $267.89
| Professional | | $267.89 | $267.89 | $267.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $869.49 / $4,249.00 / $16,394.00
| Facility | | $869.49 | $4,249.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.21 / $430.11 / $2,741.00
| Professional | | $238.21 | $430.11 | $2,741.00 |
- 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
- $238.21 / $360.61 / $715.21
| Professional | | $238.21 | $360.61 | $715.21 |