- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.23 / $1,919.00 / $3,469.00
| Facility | | $126.23 | $1,919.00 | $3,469.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.50 / $126.23 / $245.98
| Professional | | $71.50 | $126.23 | $245.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.53 / $736.00 / $3,445.00
| Facility | | $222.53 | $736.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.51 / $246.67 / $694.63
| Professional | | $101.51 | $246.67 | $694.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.74 / $136.16 / $267.08
| Facility | | $104.74 | $136.16 | $267.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.44 / $178.91 / $282.67
| Professional | | $97.44 | $178.91 | $282.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.36 / $229.14 / $476.73
| Professional | | $133.36 | $229.14 | $476.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.44 / $300.00 / $6,679.00
| Facility | | $92.44 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.58 / $244.67 / $337.74
| Professional | | $194.58 | $244.67 | $337.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.51 / $245.35 / $481.76
| Professional | | $115.51 | $245.35 | $481.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $221.63 / $307.13 / $571.54
| Facility | | $221.63 | $307.13 | $571.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $16,394.00
| Facility | | $627.00 | $1,818.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.69 / $334.18 / $1,388.47
| Professional | | $206.69 | $334.18 | $1,388.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.94 / $268.55 / $481.76
| Professional | | $182.94 | $268.55 | $481.76 |