- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.02 / $1,886.00 / $3,693.00
| Facility | | $93.02 | $1,886.00 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.17 / $97.35 / $271.79
| Professional | | $58.17 | $97.35 | $271.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.71 / $941.10 / $4,142.00
| Facility | | $171.71 | $941.10 | $4,142.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.45 / $167.10 / $512.96
| Professional | | $76.45 | $167.10 | $512.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.91 / $106.48 / $187.90
| Facility | | $81.91 | $106.48 | $187.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.15 / $181.96 / $287.42
| Professional | | $111.15 | $181.96 | $287.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.18 / $169.23 / $373.12
| Professional | | $90.18 | $169.23 | $373.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.25 / $168.26 / $6,679.00
| Facility | | $83.25 | $168.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.75 / $160.88 / $222.08
| Professional | | $127.75 | $160.88 | $222.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.65 / $183.42 / $314.82
| Professional | | $87.65 | $183.42 | $314.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $917.42 / $917.42 / $2,032.88
| Facility | | $917.42 | $917.42 | $2,032.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.62 / $182.88 / $187.52
| Professional | | $179.62 | $182.88 | $187.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $348.13 / $1,818.00 / $12,000.00
| Facility | | $348.13 | $1,818.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.45 / $229.50 / $830.32
| Professional | | $110.45 | $229.50 | $830.32 |
- 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
- $93.51 / $167.00 / $313.54
| Professional | | $93.51 | $167.00 | $313.54 |