- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.43 / $2,083.00 / $3,625.00
| Facility | | $120.43 | $2,083.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.39 / $120.43 / $168.73
| Professional | | $107.39 | $120.43 | $168.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $364.07 / $4,287.00 / $12,000.00
| Facility | | $364.07 | $4,287.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.56 / $230.58 / $828.80
| Professional | | $112.56 | $230.58 | $828.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.37 / $3,264.86 / $3,264.86
| Professional | | $452.37 | $3,264.86 | $3,264.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.00 / $500.00 / $9,444.77
| Facility | | $443.00 | $500.00 | $9,444.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.00 / $216.89 / $403.06
| Professional | | $120.00 | $216.89 | $403.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.14 / $377.00 / $6,679.00
| Facility | | $117.14 | $377.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.78 / $166.52 / $249.13
| Professional | | $131.78 | $166.52 | $249.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.41 / $287.04 / $380.26
| Professional | | $145.41 | $287.04 | $380.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $559.00 / $5,572.00 / $24,066.40
| Facility | | $559.00 | $5,572.00 | $24,066.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.07 / $230.58 / $828.80
| Professional | | $123.07 | $230.58 | $828.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $4,402.00 / $9,212.00
| Facility | | $1,485.00 | $4,402.00 | $9,212.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.80 / $165.29 / $428.81
| Professional | | $115.80 | $165.29 | $428.81 |