- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $197.28 / $2,618.00 / $3,693.00
| Facility | | $197.28 | $2,618.00 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.00 / $215.16 / $550.00
| Professional | | $175.00 | $215.16 | $550.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.51 / $3,764.00 / $12,379.00
| Facility | | $464.51 | $3,764.00 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.12 / $392.75 / $2,108.00
| Professional | | $193.12 | $392.75 | $2,108.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $221.75 / $288.27 / $508.69
| Facility | | $221.75 | $288.27 | $508.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.51 / $442.61 / $789.71
| Professional | | $282.51 | $442.61 | $789.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.93 / $420.98 / $812.17
| Professional | | $239.93 | $420.98 | $812.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.16 / $404.34 / $6,679.00
| Facility | | $191.16 | $404.34 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.44 / $283.18 / $446.80
| Professional | | $154.44 | $283.18 | $446.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.89 / $507.32 / $713.66
| Professional | | $238.89 | $507.32 | $713.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,704.96 / $2,647.40 / $17,710.28
| Facility | | $1,704.96 | $2,647.40 | $17,710.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.24 / $290.47 / $596.02
| Professional | | $145.24 | $290.47 | $596.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $944.40 / $4,249.00 / $16,394.00
| Facility | | $944.40 | $4,249.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.99 / $462.06 / $2,108.00
| Professional | | $258.99 | $462.06 | $2,108.00 |
- 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
- $255.61 / $392.75 / $713.66
| Professional | | $255.61 | $392.75 | $713.66 |