- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $402.05 / $1,803.00 / $3,384.99
| Facility | | $402.05 | $1,803.00 | $3,384.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.63 / $134.80 / $389.60
| Professional | | $95.63 | $134.80 | $389.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.01 / $1,339.09 / $3,804.00
| Facility | | $251.01 | $1,339.09 | $3,804.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.25 / $255.52 / $1,096.56
| Professional | | $121.25 | $255.52 | $1,096.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.44 / $170.89 / $301.55
| Facility | | $131.44 | $170.89 | $301.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.69 / $221.81 / $498.19
| Professional | | $124.69 | $221.81 | $498.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.75 / $267.13 / $448.94
| Professional | | $137.75 | $267.13 | $448.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.05 / $214.32 / $6,679.00
| Facility | | $112.05 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.43 / $176.85 / $278.27
| Professional | | $97.43 | $176.85 | $278.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.55 / $297.08 / $417.68
| Professional | | $138.55 | $297.08 | $417.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.32 / $545.29 / $981.59
| Facility | | $400.32 | $545.29 | $981.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.04 / $159.38 / $246.79
| Professional | | $137.04 | $159.38 | $246.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,878.00 / $7,161.00
| Facility | | $55.00 | $1,878.00 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.61 / $355.85 / $1,096.56
| Professional | | $150.61 | $355.85 | $1,096.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,408.00 / $5,683.00
| Facility | | $1,106.00 | $2,408.00 | $5,683.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.61 / $192.78 / $471.82
| Professional | | $112.61 | $192.78 | $471.82 |