- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.38 / $2,067.00 / $3,625.00
| Facility | | $108.38 | $2,067.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.17 / $132.58 / $356.00
| Professional | | $75.17 | $132.58 | $356.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.56 / $1,251.81 / $3,472.00
| Facility | | $202.56 | $1,251.81 | $3,472.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.16 / $210.48 / $661.60
| Professional | | $98.16 | $210.48 | $661.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.31 / $135.60 / $239.29
| Facility | | $104.31 | $135.60 | $239.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.84 / $171.59 / $285.83
| Professional | | $118.84 | $171.59 | $285.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.83 / $186.39 / $376.41
| Professional | | $102.83 | $186.39 | $376.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.49 / $190.20 / $6,679.00
| Facility | | $91.49 | $190.20 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.66 / $198.76 / $274.37
| Professional | | $158.66 | $198.76 | $274.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.05 / $239.67 / $426.20
| Professional | | $113.05 | $239.67 | $426.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $541.65 / $541.65 / $541.65
| Facility | | $541.65 | $541.65 | $541.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,600.00 / $7,161.00
| Facility | | $55.00 | $1,600.00 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.69 / $270.25 / $1,036.24
| Professional | | $158.69 | $270.25 | $1,036.24 |
- 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
- $134.30 / $205.43 / $391.43
| Professional | | $134.30 | $205.43 | $391.43 |