- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.63 / $2,079.00 / $3,625.00
| Facility | | $170.63 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.84 / $134.38 / $239.12
| Professional | | $79.84 | $134.38 | $239.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.48 / $1,177.70 / $3,472.00
| Facility | | $126.48 | $1,177.70 | $3,472.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.06 / $212.88 / $571.52
| Professional | | $96.06 | $212.88 | $571.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.13 / $114.53 / $204.46
| Facility | | $89.13 | $114.53 | $204.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.50 / $189.10 / $366.80
| Professional | | $104.50 | $189.10 | $366.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $300.00 / $6,679.00
| Facility | | $83.43 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.46 / $183.47 / $252.74
| Professional | | $151.46 | $183.47 | $252.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.64 / $212.31 / $388.78
| Professional | | $100.64 | $212.31 | $388.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.75 / $485.59 / $982.93
| Facility | | $358.75 | $485.59 | $982.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.66 / $123.66 / $126.80
| Professional | | $123.66 | $123.66 | $126.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,600.00 / $7,161.00
| Facility | | $55.00 | $1,600.00 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.75 / $294.23 / $1,240.00
| Professional | | $173.75 | $294.23 | $1,240.00 |
- 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
- $164.29 / $256.68 / $463.78
| Professional | | $164.29 | $256.68 | $463.78 |