- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.04 / $1,473.20 / $3,363.00
| Facility | | $93.04 | $1,473.20 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.20 / $134.33 / $219.16
| Professional | | $83.20 | $134.33 | $219.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98.17 / $845.00 / $3,472.00
| Facility | | $98.17 | $845.00 | $3,472.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.84 / $257.23 / $1,206.56
| Professional | | $122.84 | $257.23 | $1,206.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.72 / $142.28 / $253.99
| Facility | | $110.72 | $142.28 | $253.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.57 / $998.83 / $998.83
| Professional | | $181.57 | $998.83 | $998.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $216.17 / $272.17 / $500.00
| Facility | | $216.17 | $272.17 | $500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.64 / $223.60 / $460.22
| Professional | | $114.64 | $223.60 | $460.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.81 / $201.88 / $6,679.00
| Facility | | $92.81 | $201.88 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.11 / $253.88 / $362.16
| Professional | | $195.11 | $253.88 | $362.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.85 / $253.13 / $457.26
| Professional | | $134.85 | $253.13 | $457.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $953.53 / $3,804.00
| Facility | | $55.00 | $953.53 | $3,804.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.13 / $402.62 / $1,206.56
| Professional | | $169.13 | $402.62 | $1,206.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $473.00 / $1,878.00 / $4,142.00
| Facility | | $473.00 | $1,878.00 | $4,142.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.84 / $236.81 / $658.76
| Professional | | $155.84 | $236.81 | $658.76 |