- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.53 / $1,823.00 / $3,363.00
| Facility | | $81.53 | $1,823.00 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.09 / $199.72 / $351.58
| Professional | | $80.09 | $199.72 | $351.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.64 / $1,550.33 / $12,000.00
| Facility | | $265.64 | $1,550.33 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.13 / $420.70 / $2,015.76
| Professional | | $125.13 | $420.70 | $2,015.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.92 / $125.83 / $249.70
| Facility | | $97.92 | $125.83 | $249.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.64 / $165.46 / $642.02
| Professional | | $68.64 | $165.46 | $642.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.00 / $500.00 / $1,089.54
| Facility | | $443.00 | $500.00 | $1,089.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.53 / $276.63 / $785.45
| Professional | | $108.53 | $276.63 | $785.45 |
- 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
- $329.28 / $431.00 / $611.20
| Professional | | $329.28 | $431.00 | $611.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.36 / $348.16 / $772.95
| Professional | | $126.36 | $348.16 | $772.95 |
- 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
- $277.17 / $685.68 / $2,015.76
| Professional | | $277.17 | $685.68 | $2,015.76 |
- 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
- $239.55 / $420.70 / $1,038.73
| Professional | | $239.55 | $420.70 | $1,038.73 |