- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.53 / $2,079.00 / $3,625.00
| Facility | | $150.53 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.44 / $153.22 / $340.39
| Professional | | $91.44 | $153.22 | $340.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.58 / $1,878.00 / $7,161.00
| Facility | | $302.58 | $1,878.00 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.04 / $290.20 / $895.76
| Professional | | $137.04 | $290.20 | $895.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.60 / $190.58 / $336.30
| Facility | | $146.60 | $190.58 | $336.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.94 / $304.44 / $499.36
| Professional | | $198.94 | $304.44 | $499.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.33 / $257.72 / $532.16
| Professional | | $138.33 | $257.72 | $532.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.92 / $214.32 / $6,679.00
| Facility | | $125.92 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.23 / $279.02 / $385.83
| Professional | | $220.23 | $279.02 | $385.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.37 / $323.02 / $583.66
| Professional | | $152.37 | $323.02 | $583.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $876.74 / $876.74 / $6,356.53
| Facility | | $876.74 | $876.74 | $6,356.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.10 / $2,078.00 / $11,500.00
| Facility | | $627.10 | $2,078.00 | $11,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.96 / $368.80 / $1,423.04
| Professional | | $192.96 | $368.80 | $1,423.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,408.00 / $5,683.00
| Facility | | $1,106.00 | $2,408.00 | $5,683.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.87 / $290.20 / $693.79
| Professional | | $175.87 | $290.20 | $693.79 |