- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.79 / $1,823.00 / $3,363.00
| Facility | | $107.79 | $1,823.00 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.74 / $167.83 / $280.80
| Professional | | $102.74 | $167.83 | $280.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.20 / $1,689.00 / $12,000.00
| Facility | | $330.20 | $1,689.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.06 / $346.41 / $1,597.44
| Professional | | $156.06 | $346.41 | $1,597.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.06 / $201.82 / $359.98
| Facility | | $157.06 | $201.82 | $359.98 |
- 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
- $131.22 / $272.26 / $592.47
| Professional | | $131.22 | $272.26 | $592.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.05 / $377.00 / $6,679.00
| Facility | | $106.05 | $377.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.12 / $336.02 / $486.43
| Professional | | $259.12 | $336.02 | $486.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.43 / $292.27 / $614.72
| Professional | | $158.43 | $292.27 | $614.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.40 / $2,338.00 / $12,000.00
| Facility | | $599.40 | $2,338.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.17 / $543.22 / $1,597.44
| Professional | | $229.17 | $543.22 | $1,597.44 |
- 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
- $210.03 / $320.37 / $887.39
| Professional | | $210.03 | $320.37 | $887.39 |