- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.91 / $2,079.00 / $3,625.00
| Facility | | $108.91 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.73 / $115.71 / $243.84
| Professional | | $68.73 | $115.71 | $243.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.88 / $605.46 / $2,713.00
| Facility | | $193.88 | $605.46 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.39 / $202.81 / $642.16
| Professional | | $96.39 | $202.81 | $642.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.44 / $135.77 / $239.59
| Facility | | $104.44 | $135.77 | $239.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.91 / $204.80 / $343.23
| Professional | | $131.91 | $204.80 | $343.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $50.00 / $50.00
| Facility | | $50.00 | $50.00 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.21 / $181.14 / $374.49
| Professional | | $101.21 | $181.14 | $374.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.86 / $190.42 / $6,679.00
| Facility | | $89.86 | $190.42 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.63 / $199.72 / $275.93
| Professional | | $157.63 | $199.72 | $275.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.54 / $230.10 / $384.68
| Professional | | $108.54 | $230.10 | $384.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.35 / $206.98 / $233.14
| Professional | | $111.35 | $206.98 | $233.14 |
- 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
- $138.11 / $267.23 / $1,021.52
| Professional | | $138.11 | $267.23 | $1,021.52 |
- 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
- $110.32 / $194.16 / $388.18
| Professional | | $110.32 | $194.16 | $388.18 |