- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.61 / $1,823.00 / $3,625.00
| Facility | | $97.61 | $1,823.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.65 / $110.54 / $350.63
| Professional | | $53.65 | $110.54 | $350.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $113.13 / $502.00 / $2,733.00
| Facility | | $113.13 | $502.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.43 / $154.82 / $728.37
| Professional | | $65.43 | $154.82 | $728.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.44 / $78.56 / $152.47
| Facility | | $60.44 | $78.56 | $152.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.78 / $131.50 / $302.00
| Professional | | $24.78 | $131.50 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.23 / $159.69 / $309.44
| Professional | | $79.23 | $159.69 | $309.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.37 / $168.26 / $6,679.00
| Facility | | $61.37 | $168.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.83 / $119.07 / $181.76
| Professional | | $61.83 | $119.07 | $181.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.92 / $142.44 / $266.43
| Professional | | $65.92 | $142.44 | $266.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $296.67 / $296.67 / $621.65
| Facility | | $296.67 | $296.67 | $621.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,078.00 / $3,445.00
| Facility | | $55.00 | $1,078.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.26 / $255.28 / $728.37
| Professional | | $127.26 | $255.28 | $728.37 |
- 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
- $110.66 / $182.59 / $356.48
| Professional | | $110.66 | $182.59 | $356.48 |