- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.16 / $2,410.00 / $3,625.00
| Facility | | $109.16 | $2,410.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.35 / $122.54 / $225.79
| Professional | | $47.35 | $122.54 | $225.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.37 / $627.00 / $2,733.00
| Facility | | $103.37 | $627.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.09 / $216.09 / $1,074.22
| Professional | | $58.09 | $216.09 | $1,074.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.35 / $67.70 / $122.38
| Facility | | $53.35 | $67.70 | $122.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.80 / $137.02 / $284.55
| Professional | | $74.80 | $137.02 | $284.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.60 / $123.90 / $349.49
| Professional | | $59.60 | $123.90 | $349.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.00 / $166.70 / $6,679.00
| Facility | | $53.00 | $166.70 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.57 / $168.64 / $295.00
| Professional | | $130.57 | $168.64 | $295.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.88 / $144.85 / $319.08
| Professional | | $66.88 | $144.85 | $319.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.36 / $74.19 / $338.00
| Professional | | $72.36 | $74.19 | $338.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.86 / $953.00 / $2,796.00
| Facility | | $226.86 | $953.00 | $2,796.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.47 / $334.99 / $1,074.22
| Professional | | $141.47 | $334.99 | $1,074.22 |
- 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
- $132.53 / $242.88 / $400.52
| Professional | | $132.53 | $242.88 | $400.52 |