- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $163.53 / $2,079.00 / $3,625.00
| Facility | | $163.53 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.30 / $176.30 / $347.63
| Professional | | $133.30 | $176.30 | $347.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $321.76 / $1,798.55 / $8,498.00
| Facility | | $321.76 | $1,798.55 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.62 / $238.00 / $955.76
| Professional | | $124.62 | $238.00 | $955.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.25 / $200.22 / $353.85
| Facility | | $154.25 | $200.22 | $353.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.02 / $276.86 / $405.00
| Professional | | $195.02 | $276.86 | $405.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.27 / $119.27 / $119.27
| Facility | | $119.27 | $119.27 | $119.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.54 / $270.62 / $492.66
| Professional | | $138.54 | $270.62 | $492.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.05 / $214.32 / $6,679.00
| Facility | | $133.05 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.55 / $226.70 / $312.93
| Professional | | $180.55 | $226.70 | $312.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.56 / $335.99 / $531.28
| Professional | | $160.56 | $335.99 | $531.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.21 / $237.51 / $485.00
| Professional | | $231.21 | $237.51 | $485.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $897.84 / $3,372.00 / $11,500.00
| Facility | | $897.84 | $3,372.00 | $11,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.96 / $306.20 / $2,278.08
| Professional | | $168.96 | $306.20 | $2,278.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,245.00 / $3,372.00 / $8,425.00
| Facility | | $1,245.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.28 / $224.03 / $501.17
| Professional | | $162.28 | $224.03 | $501.17 |