- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $86.43 / $1,823.00 / $3,363.00
| Facility | | $86.43 | $1,823.00 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.55 / $144.04 / $249.94
| Professional | | $76.55 | $144.04 | $249.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.64 / $1,888.98 / $12,000.00
| Facility | | $265.64 | $1,888.98 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.27 / $304.86 / $1,431.28
| Professional | | $116.27 | $304.86 | $1,431.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.66 / $170.48 / $304.33
| Facility | | $132.66 | $170.48 | $304.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $633.32 / $1,695.28 / $1,695.28
| Professional | | $633.32 | $1,695.28 | $1,695.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.00 / $500.00 / $3,111.82
| Facility | | $443.00 | $500.00 | $3,111.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.04 / $247.58 / $538.13
| Professional | | $105.04 | $247.58 | $538.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.75 / $377.00 / $6,679.00
| Facility | | $84.75 | $377.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.79 / $302.94 / $437.58
| Professional | | $232.79 | $302.94 | $437.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.36 / $247.81 / $550.16
| Professional | | $126.36 | $247.81 | $550.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.30 / $2,338.00 / $12,000.00
| Facility | | $478.30 | $2,338.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.64 / $489.10 / $1,431.28
| Professional | | $172.64 | $489.10 | $1,431.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $3,133.00 / $8,425.00
| Facility | | $822.00 | $3,133.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.35 / $274.22 / $632.25
| Professional | | $149.35 | $274.22 | $632.25 |