- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.80 / $1,886.00 / $3,625.00
| Facility | | $115.80 | $1,886.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.71 / $166.10 / $398.62
| Professional | | $108.71 | $166.10 | $398.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.01 / $679.46 / $2,713.00
| Facility | | $223.01 | $679.46 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.17 / $244.17 / $720.56
| Professional | | $111.17 | $244.17 | $720.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.30 / $152.49 / $269.08
| Facility | | $117.30 | $152.49 | $269.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.18 / $255.21 / $405.37
| Professional | | $159.18 | $255.21 | $405.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.41 / $226.02 / $452.65
| Professional | | $114.41 | $226.02 | $452.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.93 / $213.88 / $6,679.00
| Facility | | $100.93 | $213.88 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.95 / $235.59 / $325.88
| Professional | | $185.95 | $235.59 | $325.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.06 / $258.77 / $477.18
| Professional | | $122.06 | $258.77 | $477.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.63 / $249.53 / $512.34
| Professional | | $208.63 | $249.53 | $512.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $966.90 / $3,445.00
| Facility | | $55.00 | $966.90 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.09 / $307.58 / $1,242.41
| Professional | | $192.09 | $307.58 | $1,242.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.63 / $178.35 / $359.60
| Professional | | $144.63 | $178.35 | $359.60 |
- 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
- $172.14 / $249.91 / $509.44
| Professional | | $172.14 | $249.91 | $509.44 |