- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.58 / $1,886.00 / $3,625.00
| Facility | | $103.58 | $1,886.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.47 / $111.87 / $320.37
| Professional | | $58.47 | $111.87 | $320.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.50 / $1,251.81 / $3,472.00
| Facility | | $132.50 | $1,251.81 | $3,472.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.05 / $161.46 / $456.38
| Professional | | $66.05 | $161.46 | $456.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.92 / $89.60 / $175.75
| Facility | | $68.92 | $89.60 | $175.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.94 / $153.11 / $304.52
| Professional | | $87.94 | $153.11 | $304.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.97 / $172.51 / $325.14
| Professional | | $80.97 | $172.51 | $325.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.78 / $168.26 / $6,679.00
| Facility | | $70.78 | $168.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.13 / $170.45 / $235.29
| Professional | | $135.13 | $170.45 | $235.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.14 / $161.63 / $358.26
| Professional | | $74.14 | $161.63 | $358.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $978.81 / $978.81 / $978.81
| Facility | | $978.81 | $978.81 | $978.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.34 / $192.31 / $197.19
| Professional | | $188.34 | $192.31 | $197.19 |
- 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
- $122.19 / $239.35 / $882.40
| Professional | | $122.19 | $239.35 | $882.40 |
- 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
- $112.84 / $178.31 / $367.74
| Professional | | $112.84 | $178.31 | $367.74 |