- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $88.86 / $1,103.70 / $2,747.00
| Facility | | $88.86 | $1,103.70 | $2,747.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.28 / $88.86 / $193.76
| Professional | | $32.28 | $88.86 | $193.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.74 / $1,251.81 / $3,804.00
| Facility | | $92.74 | $1,251.81 | $3,804.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.79 / $160.21 / $697.68
| Professional | | $52.79 | $160.21 | $697.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.03 / $62.44 / $122.48
| Facility | | $48.03 | $62.44 | $122.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.84 / $119.21 / $244.39
| Professional | | $67.84 | $119.21 | $244.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.05 / $162.54 / $341.26
| Professional | | $74.05 | $162.54 | $341.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $49.63 / $168.26 / $6,679.00
| Facility | | $49.63 | $168.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.05 / $141.59 / $253.16
| Professional | | $112.05 | $141.59 | $253.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.32 / $119.19 / $264.61
| Professional | | $53.32 | $119.19 | $264.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.59 / $632.99 / $1,333.46
| Facility | | $148.59 | $632.99 | $1,333.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.25 / $31.25 / $217.30
| Professional | | $31.25 | $31.25 | $217.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,878.00 / $7,161.00
| Facility | | $55.00 | $1,878.00 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.18 / $264.92 / $697.68
| Professional | | $128.18 | $264.92 | $697.68 |
- 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
- $116.28 / $162.61 / $349.17
| Professional | | $116.28 | $162.61 | $349.17 |