- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.97 / $2,067.00 / $3,625.00
| Facility | | $151.97 | $2,067.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.05 / $159.63 / $339.52
| Professional | | $116.05 | $159.63 | $339.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.17 / $640.30 / $2,713.00
| Facility | | $263.17 | $640.30 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.16 / $276.04 / $1,204.32
| Professional | | $128.16 | $276.04 | $1,204.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.78 / $168.71 / $297.72
| Facility | | $129.78 | $168.71 | $297.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.34 / $259.04 / $532.35
| Professional | | $165.34 | $259.04 | $532.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.59 / $279.85 / $520.00
| Professional | | $159.59 | $279.85 | $520.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $113.33 / $214.32 / $6,679.00
| Facility | | $113.33 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.10 / $191.69 / $309.04
| Professional | | $104.10 | $191.69 | $309.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.16 / $306.97 / $457.26
| Professional | | $143.16 | $306.97 | $457.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.88 / $426.24 / $462.71
| Facility | | $160.88 | $426.24 | $462.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.16 / $294.17 / $347.35
| Professional | | $178.16 | $294.17 | $347.35 |
- 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
- $197.64 / $417.50 / $1,204.32
| Professional | | $197.64 | $417.50 | $1,204.32 |
- 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
- $184.71 / $244.80 / $506.07
| Professional | | $184.71 | $244.80 | $506.07 |