- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.06 / $2,410.00 / $3,625.00
| Facility | | $134.06 | $2,410.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.10 / $103.32 / $190.15
| Professional | | $55.10 | $103.32 | $190.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.21 / $627.00 / $2,733.00
| Facility | | $60.21 | $627.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.81 / $165.51 / $418.32
| Professional | | $61.81 | $165.51 | $418.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.15 / $74.72 / $148.28
| Facility | | $58.15 | $74.72 | $148.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.54 / $138.91 / $281.66
| Professional | | $69.54 | $138.91 | $281.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.25 / $168.26 / $6,679.00
| Facility | | $60.25 | $168.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.44 / $152.02 / $209.84
| Professional | | $125.44 | $152.02 | $209.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.76 / $140.63 / $295.77
| Professional | | $66.76 | $140.63 | $295.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $775.60 / $775.60 / $775.60
| Facility | | $775.60 | $775.60 | $775.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.41 / $167.39 / $196.02
| Professional | | $85.41 | $167.39 | $196.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $966.90 / $3,445.00
| Facility | | $55.00 | $966.90 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.63 / $224.94 / $854.46
| Professional | | $135.63 | $224.94 | $854.46 |
- 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
- $128.43 / $205.08 / $323.54
| Professional | | $128.43 | $205.08 | $323.54 |