- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.65 / $1,886.00 / $3,363.00
| Facility | | $77.65 | $1,886.00 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.31 / $137.35 / $233.30
| Professional | | $70.31 | $137.35 | $233.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.18 / $1,689.00 / $12,000.00
| Facility | | $230.18 | $1,689.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.42 / $273.33 / $1,272.24
| Professional | | $108.42 | $273.33 | $1,272.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.19 / $149.30 / $266.54
| Facility | | $116.19 | $149.30 | $266.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $633.32 / $711.49 / $711.49
| Professional | | $633.32 | $711.49 | $711.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.00 / $500.00 / $1,408.94
| Facility | | $443.00 | $500.00 | $1,408.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.52 / $221.06 / $478.16
| Professional | | $93.52 | $221.06 | $478.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $377.00 / $6,679.00
| Facility | | $83.43 | $377.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.06 / $268.18 / $399.24
| Professional | | $206.06 | $268.18 | $399.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.58 / $218.32 / $484.69
| Professional | | $108.58 | $218.32 | $484.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $415.25 / $2,338.00 / $12,000.00
| Facility | | $415.25 | $2,338.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.32 / $432.47 / $1,272.24
| Professional | | $175.32 | $432.47 | $1,272.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $669.00 / $2,338.00 / $4,952.00
| Facility | | $669.00 | $2,338.00 | $4,952.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.11 / $278.11 / $795.72
| Professional | | $156.11 | $278.11 | $795.72 |