- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.68 / $2,494.00 / $3,575.00
| Facility | | $215.68 | $2,494.00 | $3,575.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.95 / $215.68 / $344.50
| Professional | | $75.95 | $215.68 | $344.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $240.26 / $1,251.81 / $3,804.00
| Facility | | $240.26 | $1,251.81 | $3,804.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.91 / $400.28 / $993.79
| Professional | | $107.91 | $400.28 | $993.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.29 / $144.68 / $283.79
| Facility | | $111.29 | $144.68 | $283.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.08 / $222.13 / $621.37
| Professional | | $111.08 | $222.13 | $621.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.34 / $428.57 / $844.13
| Professional | | $173.34 | $428.57 | $844.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.00 / $202.92 / $8,090.00
| Facility | | $96.00 | $202.92 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.64 / $373.58 / $667.93
| Professional | | $295.64 | $373.58 | $667.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.01 / $312.93 / $693.14
| Professional | | $123.01 | $312.93 | $693.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,005.34 / $2,005.34 / $2,005.34
| Facility | | $2,005.34 | $2,005.34 | $2,005.34 |
- 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
- $323.97 / $601.65 / $1,840.56
| Professional | | $323.97 | $601.65 | $1,840.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.00 / $2,408.00 / $7,161.00
| Facility | | $950.00 | $2,408.00 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.93 / $439.25 / $901.42
| Professional | | $312.93 | $439.25 | $901.42 |