- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.41 / $3,745.00 / $7,629.00
| Facility | | $160.41 | $3,745.00 | $7,629.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.38 / $143.16 / $204.20
| Professional | | $91.38 | $143.16 | $204.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,299.82 / $2,746.00 / $13,822.74
| Facility | | $2,299.82 | $2,746.00 | $13,822.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.28 / $175.67 / $328.86
| Professional | | $169.28 | $175.67 | $328.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.69 / $163.18 / $273.58
| Professional | | $100.69 | $163.18 | $273.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.58 / $261.75 / $270.27
| Professional | | $203.58 | $261.75 | $270.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.25 / $173.25 / $173.25
| Professional | | $173.25 | $173.25 | $173.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.00 / $3,964.00 / $8,017.00
| Facility | | $832.00 | $3,964.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.93 / $160.41 / $963.48
| Professional | | $94.93 | $160.41 | $963.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.40 / $169.40 / $178.40
| Professional | | $169.40 | $169.40 | $178.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $180.74 / $180.74 / $180.74
| Facility | | $180.74 | $180.74 | $180.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.71 / $166.62 / $281.05
| Professional | | $103.71 | $166.62 | $281.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.60 / $117.71 / $181.16
| Facility | | $102.60 | $117.71 | $181.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.60 / $164.29 / $179.57
| Professional | | $102.60 | $164.29 | $179.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.00 / $650.00 / $4,300.00
| Facility | | $144.00 | $650.00 | $4,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.69 / $188.61 / $348.11
| Professional | | $152.69 | $188.61 | $348.11 |