- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $314.36 / $2,079.00 / $3,625.00
| Facility | | $314.36 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.94 / $311.77 / $698.38
| Professional | | $94.94 | $311.77 | $698.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.68 / $627.00 / $2,733.00
| Facility | | $188.68 | $627.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.97 / $768.15 / $3,451.92
| Professional | | $106.97 | $768.15 | $3,451.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.87 / $122.93 / $222.22
| Facility | | $96.87 | $122.93 | $222.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.52 / $716.78 / $1,201.25
| Professional | | $132.52 | $716.78 | $1,201.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.34 / $246.18 / $1,225.86
| Professional | | $110.34 | $246.18 | $1,225.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.31 / $176.64 / $6,679.00
| Facility | | $85.31 | $176.64 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $564.23 / $738.78 / $1,256.48
| Professional | | $564.23 | $738.78 | $1,256.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.48 / $353.58 / $1,326.38
| Professional | | $122.48 | $353.58 | $1,326.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.70 / $183.70 / $183.70
| Professional | | $183.70 | $183.70 | $183.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $953.00 / $2,796.00
| Facility | | $308.00 | $953.00 | $2,796.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.98 / $1,174.79 / $3,451.92
| Professional | | $492.98 | $1,174.79 | $3,451.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.96 / $796.51 / $2,011.11
| Professional | | $153.96 | $796.51 | $2,011.11 |