- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $113.17 / $1,819.00 / $7,197.00
| Facility | | $113.17 | $1,819.00 | $7,197.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.75 / $110.59 / $200.92
| Professional | | $74.75 | $110.59 | $200.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,083.51 / $1,395.00 / $12,759.45
| Facility | | $1,083.51 | $1,395.00 | $12,759.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.00 / $150.41 / $211.55
| Professional | | $109.00 | $150.41 | $211.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.58 / $134.57 / $227.36
| Professional | | $90.58 | $134.57 | $227.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.13 / $196.75 / $198.06
| Professional | | $148.13 | $196.75 | $198.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $272.00 / $272.00 / $903.11
| Facility | | $272.00 | $272.00 | $903.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $2,070.00 / $7,799.00
| Facility | | $490.00 | $2,070.00 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.45 / $121.84 / $283.99
| Professional | | $79.45 | $121.84 | $283.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $146.90 / $327.00
| Professional | | $3.00 | $146.90 | $327.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.75 / $139.88 / $229.90
| Professional | | $93.75 | $139.88 | $229.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.85 / $102.00 / $130.57
| Facility | | $82.85 | $102.00 | $130.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.85 / $119.30 / $130.35
| Professional | | $82.85 | $119.30 | $130.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.00 / $557.00 / $3,742.00
| Facility | | $162.00 | $557.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.84 / $143.52 / $236.13
| Professional | | $108.84 | $143.52 | $236.13 |