- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.87 / $2,663.12 / $7,625.00
| Facility | | $126.87 | $2,663.12 | $7,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.34 / $105.81 / $193.51
| Professional | | $57.34 | $105.81 | $193.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $99.74 / $1,177.70 / $3,472.00
| Facility | | $99.74 | $1,177.70 | $3,472.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.73 / $161.96 / $1,094.00
| Professional | | $69.73 | $161.96 | $1,094.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $71.92 / $92.42 / $179.35
| Facility | | $71.92 | $92.42 | $179.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.63 / $165.58 / $355.25
| Professional | | $91.63 | $165.58 | $355.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.75 / $143.08 / $281.16
| Professional | | $79.75 | $143.08 | $281.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.31 / $221.48 / $6,679.00
| Facility | | $70.31 | $221.48 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.58 / $161.81 / $223.08
| Professional | | $133.58 | $161.81 | $223.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.70 / $172.37 / $342.52
| Professional | | $81.70 | $172.37 | $342.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.77 / $469.49 / $3,863.50
| Facility | | $47.77 | $469.49 | $3,863.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.25 / $149.03 / $204.62
| Professional | | $62.25 | $149.03 | $204.62 |
- 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
- $91.30 / $201.78 / $1,094.00
| Professional | | $91.30 | $201.78 | $1,094.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.78 / $26.16 / $273.16
| Facility | | $23.78 | $26.16 | $273.16 |
- 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
- $91.30 / $173.83 / $355.01
| Professional | | $91.30 | $173.83 | $355.01 |