- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.62 / $2,663.12 / $4,806.64
| Facility | | $67.62 | $2,663.12 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.34 / $115.22 / $219.86
| Professional | | $65.34 | $115.22 | $219.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.46 / $766.65 / $2,733.00
| Facility | | $141.46 | $766.65 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.43 / $194.26 / $3,844.84
| Professional | | $76.43 | $194.26 | $3,844.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.64 / $96.89 / $173.52
| Facility | | $75.64 | $96.89 | $173.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.84 / $184.68 / $337.36
| Professional | | $106.84 | $184.68 | $337.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.65 / $147.91 / $344.54
| Professional | | $75.65 | $147.91 | $344.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $76.53 / $300.00 / $6,679.00
| Facility | | $76.53 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.19 / $147.44 / $243.50
| Professional | | $79.19 | $147.44 | $243.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.85 / $181.51 / $359.57
| Professional | | $91.85 | $181.51 | $359.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.28 / $158.28 / $728.54
| Facility | | $158.28 | $158.28 | $728.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.08 / $140.44 / $977.50
| Professional | | $100.08 | $140.44 | $977.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $953.00 / $2,796.00
| Facility | | $308.00 | $953.00 | $2,796.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.79 / $327.32 / $3,844.84
| Professional | | $123.79 | $327.32 | $3,844.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.79 / $190.58 / $557.47
| Professional | | $123.79 | $190.58 | $557.47 |