- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.47 / $2,079.00 / $3,625.00
| Facility | | $110.47 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.18 / $110.47 / $200.47
| Professional | | $86.18 | $110.47 | $200.47 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $313.11 / $313.11 / $313.11
| Professional | 50 | $313.11 | $313.11 | $313.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.34 / $536.38 / $2,713.00
| Facility | | $173.34 | $536.38 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.60 / $235.25 / $1,030.72
| Professional | | $109.60 | $235.25 | $1,030.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.65 / $160.18 / $285.95
| Facility | | $124.65 | $160.18 | $285.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.24 / $199.12 / $772.78
| Professional | | $118.24 | $199.12 | $772.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.31 / $208.72 / $375.94
| Professional | | $126.31 | $208.72 | $375.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.89 / $268.82 / $6,679.00
| Facility | | $104.89 | $268.82 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.82 / $203.15 / $280.42
| Professional | | $166.82 | $203.15 | $280.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.86 / $287.33 / $447.83
| Professional | | $134.86 | $287.33 | $447.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,125.08 / $3,125.08 / $3,125.08
| Facility | | $3,125.08 | $3,125.08 | $3,125.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.00 / $213.00 / $213.00
| Professional | | $213.00 | $213.00 | $213.00 |
- 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
- $125.01 / $263.49 / $1,030.72
| Professional | | $125.01 | $263.49 | $1,030.72 |
- 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
- $130.63 / $223.06 / $432.17
| Professional | | $130.63 | $223.06 | $432.17 |