- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.23 / $2,083.00 / $3,625.00
| Facility | | $253.23 | $2,083.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.42 / $253.23 / $1,096.85
| Professional | | $101.42 | $253.23 | $1,096.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.61 / $1,071.64 / $4,569.00
| Facility | | $111.61 | $1,071.64 | $4,569.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.82 / $1,020.66 / $3,215.94
| Professional | | $162.82 | $1,020.66 | $3,215.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.80 / $148.80 / $295.29
| Facility | | $115.80 | $148.80 | $295.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.12 / $137.91 / $1,386.27
| Professional | | $46.12 | $137.91 | $1,386.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $748.00 / $1,408.94
| Facility | | $680.00 | $748.00 | $1,408.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.71 / $529.32 / $1,868.33
| Professional | | $146.71 | $529.32 | $1,868.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98.68 / $211.16 / $6,679.00
| Facility | | $98.68 | $211.16 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $752.79 / $954.68 / $1,397.34
| Professional | | $752.79 | $954.68 | $1,397.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.07 / $669.86 / $1,745.58
| Professional | | $148.07 | $669.86 | $1,745.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,267.00 / $4,755.00
| Facility | | $55.00 | $1,267.00 | $4,755.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $754.53 / $1,282.70 / $4,599.43
| Professional | | $754.53 | $1,282.70 | $4,599.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $2,338.00 / $4,755.00
| Facility | | $822.00 | $2,338.00 | $4,755.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $642.76 / $995.54 / $2,263.59
| Professional | | $642.76 | $995.54 | $2,263.59 |