- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.45 / $2,094.00 / $4,088.00
| Facility | | $115.45 | $2,094.00 | $4,088.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.08 / $123.64 / $371.34
| Professional | | $54.08 | $123.64 | $371.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.62 / $2,329.00 / $4,755.00
| Facility | | $152.62 | $2,329.00 | $4,755.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.90 / $206.05 / $996.80
| Professional | | $79.90 | $206.05 | $996.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.77 / $106.30 / $208.51
| Facility | | $81.77 | $106.30 | $208.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.09 / $134.09 / $278.95
| Professional | | $134.09 | $134.09 | $278.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.71 / $218.52 / $455.26
| Professional | | $110.71 | $218.52 | $455.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.03 / $168.26 / $6,679.00
| Facility | | $82.03 | $168.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.02 / $203.46 / $363.75
| Professional | | $161.02 | $203.46 | $363.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.33 / $188.72 / $378.28
| Professional | | $87.33 | $188.72 | $378.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.40 / $126.40 / $126.40
| Professional | | $126.40 | $126.40 | $126.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,376.00 / $8,498.00
| Facility | | $55.00 | $2,376.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.91 / $360.67 / $996.80
| Professional | | $146.91 | $360.67 | $996.80 |
- 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
- $138.94 / $224.28 / $455.44
| Professional | | $138.94 | $224.28 | $455.44 |