- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.08 / $1,537.29 / $3,363.00
| Facility | | $112.08 | $1,537.29 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.56 / $95.58 / $158.10
| Professional | | $51.56 | $95.58 | $158.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.35 / $604.07 / $3,381.00
| Facility | | $59.35 | $604.07 | $3,381.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.87 / $162.72 / $753.03
| Professional | | $75.87 | $162.72 | $753.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $62.48 / $80.29 / $143.33
| Facility | | $62.48 | $80.29 | $143.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.18 / $121.08 / $254.85
| Professional | | $71.18 | $121.08 | $254.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.66 / $141.84 / $500.00
| Facility | | $112.66 | $141.84 | $500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.09 / $139.32 / $310.52
| Professional | | $69.09 | $139.32 | $310.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.92 / $168.26 / $6,679.00
| Facility | | $53.92 | $168.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.09 / $141.19 / $245.96
| Professional | | $109.09 | $141.19 | $245.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.84 / $144.26 / $255.85
| Professional | | $76.84 | $144.26 | $255.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $410.48 / $425.29 / $1,626.89
| Facility | | $410.48 | $425.29 | $1,626.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.71 / $165.45 / $193.63
| Professional | | $159.71 | $165.45 | $193.63 |
- 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
- $121.80 / $251.74 / $753.03
| Professional | | $121.80 | $251.74 | $753.03 |
- 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
- $106.46 / $162.05 / $369.96
| Professional | | $106.46 | $162.05 | $369.96 |