- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $187.53 / $2,079.00 / $3,625.00
| Facility | | $187.53 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.97 / $199.10 / $575.23
| Professional | | $134.97 | $199.10 | $575.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.66 / $2,329.00 / $4,755.00
| Facility | | $363.66 | $2,329.00 | $4,755.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.04 / $410.23 / $1,573.84
| Professional | | $170.04 | $410.23 | $1,573.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.67 / $250.47 / $441.98
| Facility | | $192.67 | $250.47 | $441.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.95 / $315.95 / $432.26
| Professional | | $315.95 | $315.95 | $432.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.28 / $424.25 / $717.61
| Professional | | $233.28 | $424.25 | $717.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.26 / $300.00 / $8,090.00
| Facility | | $162.26 | $300.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.97 / $318.39 / $555.10
| Professional | | $251.97 | $318.39 | $555.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.72 / $441.10 / $597.45
| Professional | | $205.72 | $441.10 | $597.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,922.58 / $3,922.58 / $3,922.58
| Facility | | $3,922.58 | $3,922.58 | $3,922.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.06 / $466.98 / $466.98
| Professional | | $402.06 | $466.98 | $466.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,376.00 / $8,498.00
| Facility | | $55.00 | $2,376.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.25 / $584.34 / $1,573.84
| Professional | | $245.25 | $584.34 | $1,573.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.03 / $348.96 / $731.54
| Professional | | $231.03 | $348.96 | $731.54 |