- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $159.36 / $2,663.12 / $3,625.00
| Facility | | $159.36 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.33 / $199.96 / $431.63
| Professional | | $119.33 | $199.96 | $431.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $459.16 / $2,575.00 / $5,714.00
| Facility | | $459.16 | $2,575.00 | $5,714.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.15 / $373.80 / $1,596.80
| Professional | | $183.15 | $373.80 | $1,596.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $167.57 / $217.84 / $384.41
| Facility | | $167.57 | $217.84 | $384.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.48 / $342.80 / $760.66
| Professional | | $213.48 | $342.80 | $760.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.41 / $357.38 / $603.36
| Professional | | $176.41 | $357.38 | $603.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $145.63 / $229.16 / $6,679.00
| Facility | | $145.63 | $229.16 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.76 / $257.95 / $415.88
| Professional | | $140.76 | $257.95 | $415.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.41 / $401.51 / $621.10
| Professional | | $186.41 | $401.51 | $621.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.50 / $216.50 / $366.78
| Professional | | $216.50 | $216.50 | $366.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $9,039.00
| Facility | | $55.00 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.78 / $561.85 / $1,596.80
| Professional | | $245.78 | $561.85 | $1,596.80 |
- 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
- $234.08 / $334.65 / $679.59
| Professional | | $234.08 | $334.65 | $679.59 |