- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.11 / $2,079.00 / $3,625.00
| Facility | | $176.11 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.31 / $156.28 / $296.17
| Professional | | $97.31 | $156.28 | $296.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.19 / $1,798.55 / $4,689.00
| Facility | | $224.19 | $1,798.55 | $4,689.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.98 / $246.92 / $801.00
| Professional | | $104.98 | $246.92 | $801.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.64 / $146.43 / $281.72
| Facility | | $112.64 | $146.43 | $281.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.91 / $250.23 / $475.15
| Professional | | $157.91 | $250.23 | $475.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.80 / $650.80 / $650.80
| Facility | | $650.80 | $650.80 | $650.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.08 / $240.73 / $530.16
| Professional | | $134.08 | $240.73 | $530.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.02 / $205.38 / $6,679.00
| Facility | | $97.02 | $205.38 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $252.80 / $350.42
| Professional | | $199.53 | $252.80 | $350.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.15 / $258.55 / $573.07
| Professional | | $117.15 | $258.55 | $573.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.65 / $66.65 / $66.65
| Professional | | $66.65 | $66.65 | $66.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,338.00 / $8,498.00
| Facility | | $55.00 | $2,338.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.85 / $338.29 / $2,902.12
| Professional | | $189.85 | $338.29 | $2,902.12 |
- 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
- $177.50 / $262.86 / $616.09
| Professional | | $177.50 | $262.86 | $616.09 |