- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.72 / $2,089.30 / $3,801.89
| Facility | | $97.72 | $2,089.30 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $100.00 / $316.23
| Professional | | $51.29 | $100.00 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $575.44 / $2,818.38
| Facility | | $56.23 | $575.44 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $114.82 / $295.12
| Professional | | $56.23 | $114.82 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $60.26 / $141.25
| Facility | | $60.26 | $60.26 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $138.04 / $269.15
| Professional | | $79.43 | $138.04 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $138.04 / $275.42
| Professional | | $74.13 | $138.04 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $177.83 / $7,079.46
| Facility | | $56.23 | $177.83 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $120.23 / $177.83
| Professional | | $63.10 | $120.23 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $123.03 / $263.03
| Professional | | $57.54 | $123.03 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $616.60 / $616.60
| Facility | | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $630.96 / $2,818.38
| Facility | | $56.23 | $630.96 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $114.82 / $295.12
| Professional | | $56.23 | $114.82 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,819.70 / $2,818.38
| Facility | | $501.19 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $125.89 / $269.15
| Professional | | $67.61 | $125.89 | $269.15 |