- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.24 / $1,013.00 / $5,750.00
| Facility | | $241.24 | $1,013.00 | $5,750.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.04 / $159.91 / $407.04
| Professional | | $90.04 | $159.91 | $407.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $673.00 / $1,359.00 / $5,044.89
| Facility | | $673.00 | $1,359.00 | $5,044.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.29 / $356.75 / $356.75
| Professional | | $237.29 | $356.75 | $356.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.08 / $190.18 / $361.60
| Professional | | $101.08 | $190.18 | $361.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.60 / $291.01 / $386.35
| Professional | | $9.60 | $291.01 | $386.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $432.34 / $1,297.48 / $2,239.30
| Facility | | $432.34 | $1,297.48 | $2,239.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.24 / $1,351.00 / $5,425.08
| Facility | | $241.24 | $1,351.00 | $5,425.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.83 / $189.66 / $544.66
| Professional | | $94.83 | $189.66 | $544.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.31 / $146.22 / $371.30
| Professional | | $108.31 | $146.22 | $371.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.87 / $175.87 / $175.87
| Facility | | $175.87 | $175.87 | $175.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.75 / $190.18 / $374.63
| Professional | | $102.75 | $190.18 | $374.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $88.11 / $101.24 / $242.25
| Facility | | $88.11 | $101.24 | $242.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.82 / $148.94 / $263.11
| Professional | | $98.82 | $148.94 | $263.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $435.00 / $1,305.00 / $4,300.00
| Facility | | $435.00 | $1,305.00 | $4,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.80 / $224.94 / $405.71
| Professional | | $157.80 | $224.94 | $405.71 |