- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.88 / $2,079.19 / $3,625.00
| Facility | | $157.88 | $2,079.19 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.03 / $176.29 / $250.35
| Professional | | $137.03 | $176.29 | $250.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $336.98 / $2,575.00 / $5,454.00
| Facility | | $336.98 | $2,575.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.12 / $232.86 / $1,088.96
| Professional | | $120.12 | $232.86 | $1,088.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.15 / $231.24 / $408.68
| Facility | | $178.15 | $231.24 | $408.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.18 / $308.27 / $410.69
| Professional | | $212.18 | $308.27 | $410.69 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $139.91 / $139.91 / $1,974.44
| Professional | 50 | $139.91 | $139.91 | $1,974.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $113.75 / $113.75 / $113.75
| Facility | | $113.75 | $113.75 | $113.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.69 / $285.16 / $497.77
| Professional | | $139.69 | $285.16 | $497.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.68 / $243.63 / $6,679.00
| Facility | | $152.68 | $243.63 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.89 / $219.43 / $302.89
| Professional | | $174.89 | $219.43 | $302.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.50 / $369.57 / $518.69
| Professional | | $183.50 | $369.57 | $518.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,628.00 / $9,039.00
| Facility | | $55.00 | $2,628.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.12 / $296.17 / $2,268.59
| Professional | | $163.12 | $296.17 | $2,268.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,715.00 / $8,766.00
| Facility | | $1,685.00 | $3,715.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.55 / $216.42 / $491.71
| Professional | | $154.55 | $216.42 | $491.71 |