- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98.47 / $2,079.00 / $3,625.00
| Facility | | $98.47 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.16 / $104.81 / $152.69
| Professional | | $79.16 | $104.81 | $152.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.60 / $2,329.00 / $4,689.00
| Facility | | $148.60 | $2,329.00 | $4,689.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.07 / $223.55 / $1,490.91
| Professional | | $99.07 | $223.55 | $1,490.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.61 / $138.28 / $246.86
| Facility | | $107.61 | $138.28 | $246.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.22 / $197.29 / $279.04
| Professional | | $140.22 | $197.29 | $279.04 |
- 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
- $114.45 / $187.19 / $337.51
| Professional | | $114.45 | $187.19 | $337.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.66 / $300.00 / $6,679.00
| Facility | | $92.66 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.59 / $176.92 / $244.22
| Professional | | $145.59 | $176.92 | $244.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.43 / $246.18 / $356.74
| Professional | | $116.43 | $246.18 | $356.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,338.00 / $8,498.00
| Facility | | $55.00 | $2,338.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.22 / $277.52 / $1,490.91
| Professional | | $140.22 | $277.52 | $1,490.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.83 / $195.64 / $394.00
| Professional | | $124.83 | $195.64 | $394.00 |