- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $2,079.00 / $3,625.00
| Facility | | $112.20 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.59 / $137.51 / $276.99
| Professional | | $71.59 | $137.51 | $276.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.10 / $1,588.55 / $3,804.00
| Facility | | $225.10 | $1,588.55 | $3,804.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.69 / $252.07 / $739.20
| Professional | | $108.69 | $252.07 | $739.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.48 / $151.41 / $267.20
| Facility | | $116.48 | $151.41 | $267.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.56 / $253.43 / $389.63
| Professional | | $173.56 | $253.43 | $389.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.55 / $272.80 / $578.29
| Professional | | $158.55 | $272.80 | $578.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.09 / $212.40 / $6,679.00
| Facility | | $102.09 | $212.40 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.23 / $221.76 / $396.50
| Professional | | $183.23 | $221.76 | $396.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.75 / $277.52 / $479.25
| Professional | | $125.75 | $277.52 | $479.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.41 / $164.41 / $164.41
| Professional | | $164.41 | $164.41 | $164.41 |
- 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
- $208.56 / $388.11 / $1,126.71
| Professional | | $208.56 | $388.11 | $1,126.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.04 / $1,930.00 / $5,683.00
| Facility | | $832.04 | $1,930.00 | $5,683.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.15 / $264.12 / $528.27
| Professional | | $200.15 | $264.12 | $528.27 |