- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $260.19 / $2,067.00 / $3,625.00
| Facility | | $260.19 | $2,067.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.79 / $217.59 / $369.46
| Professional | | $113.79 | $217.59 | $369.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.81 / $1,044.16 / $3,804.00
| Facility | | $285.81 | $1,044.16 | $3,804.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.28 / $380.45 / $1,107.96
| Professional | | $133.28 | $380.45 | $1,107.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.16 / $170.58 / $305.47
| Facility | | $133.16 | $170.58 | $305.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.70 / $300.49 / $624.03
| Professional | | $180.70 | $300.49 | $624.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.33 / $291.29 / $628.86
| Professional | | $154.33 | $291.29 | $628.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.72 / $214.32 / $6,679.00
| Facility | | $116.72 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.47 / $369.83 / $558.61
| Professional | | $286.47 | $369.83 | $558.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.35 / $355.01 / $756.94
| Professional | | $165.35 | $355.01 | $756.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,568.44 / $2,568.44 / $3,863.50
| Facility | | $2,568.44 | $2,568.44 | $3,863.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.20 / $189.20 / $189.20
| Professional | | $189.20 | $189.20 | $189.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,600.00 / $4,142.00
| Facility | | $540.00 | $1,600.00 | $4,142.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.47 / $547.90 / $1,792.00
| Professional | | $264.47 | $547.90 | $1,792.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,408.00 / $5,683.00
| Facility | | $1,106.00 | $2,408.00 | $5,683.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.37 / $399.97 / $760.55
| Professional | | $262.37 | $399.97 | $760.55 |