- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.52 / $2,663.12 / $3,693.00
| Facility | | $126.52 | $2,663.12 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.71 / $188.18 / $543.89
| Professional | | $105.71 | $188.18 | $543.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.99 / $1,339.09 / $3,804.00
| Facility | | $405.99 | $1,339.09 | $3,804.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.75 / $304.43 / $3,111.55
| Professional | | $163.75 | $304.43 | $3,111.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.13 / $192.27 / $339.81
| Facility | | $148.13 | $192.27 | $339.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.72 / $295.67 / $518.41
| Professional | | $188.72 | $295.67 | $518.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $50.00 / $50.00
| Facility | | $50.00 | $50.00 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.30 / $299.51 / $514.76
| Professional | | $156.30 | $299.51 | $514.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.96 / $214.32 / $6,679.00
| Facility | | $128.96 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.93 / $177.77 / $286.60
| Professional | | $95.93 | $177.77 | $286.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.41 / $342.50 / $489.93
| Professional | | $165.41 | $342.50 | $489.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $862.29 / $862.29 / $1,223.23
| Facility | | $862.29 | $862.29 | $1,223.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.98 / $206.98 / $212.23
| Professional | | $206.98 | $206.98 | $212.23 |
- 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
- $185.08 / $396.18 / $3,111.55
| Professional | | $185.08 | $396.18 | $3,111.55 |
- 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
- $176.72 / $233.52 / $456.46
| Professional | | $176.72 | $233.52 | $456.46 |