- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.66 / $2,663.12 / $3,625.00
| Facility | | $149.66 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.68 / $165.83 / $342.55
| Professional | | $137.68 | $165.83 | $342.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $364.69 / $3,764.00 / $12,379.00
| Facility | | $364.69 | $3,764.00 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.27 / $348.77 / $1,882.25
| Professional | | $160.27 | $348.77 | $1,882.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.87 / $226.03 / $398.86
| Facility | | $173.87 | $226.03 | $398.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.51 / $347.04 / $655.94
| Professional | | $221.51 | $347.04 | $655.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.59 / $352.76 / $645.21
| Professional | | $189.59 | $352.76 | $645.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.36 / $317.02 / $6,679.00
| Facility | | $149.36 | $317.02 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.28 / $234.19 / $369.50
| Professional | | $128.28 | $234.19 | $369.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.99 / $398.79 / $558.15
| Professional | | $185.99 | $398.79 | $558.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,941.55 / $2,941.55 / $2,941.55
| Facility | | $2,941.55 | $2,941.55 | $2,941.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.62 / $4,249.00 / $16,394.00
| Facility | | $741.62 | $4,249.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.11 / $494.89 / $1,882.25
| Professional | | $209.11 | $494.89 | $1,882.25 |
- 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
- $205.12 / $271.67 / $620.00
| Professional | | $205.12 | $271.67 | $620.00 |