- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.89 / $2,079.00 / $3,625.00
| Facility | | $177.89 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.03 / $177.89 / $443.72
| Professional | | $77.03 | $177.89 | $443.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.31 / $1,588.55 / $12,000.00
| Facility | | $199.31 | $1,588.55 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.24 / $295.56 / $1,603.00
| Professional | | $87.24 | $295.56 | $1,603.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.41 / $121.43 / $238.20
| Facility | | $93.41 | $121.43 | $238.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.94 / $245.17 / $397.88
| Professional | | $131.94 | $245.17 | $397.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.25 / $305.16 / $589.04
| Professional | | $145.25 | $305.16 | $589.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $300.00 / $6,679.00
| Facility | | $83.43 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.32 / $268.22 / $479.56
| Professional | | $223.32 | $268.22 | $479.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.99 / $225.91 / $562.10
| Professional | | $101.99 | $225.91 | $562.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,541.53 / $1,541.53 / $1,541.53
| Facility | | $1,541.53 | $1,541.53 | $1,541.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.25 / $133.25 / $133.25
| Professional | | $133.25 | $133.25 | $133.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $2,430.00 / $12,000.00
| Facility | | $540.00 | $2,430.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.77 / $544.77 / $2,322.16
| Professional | | $272.77 | $544.77 | $2,322.16 |
- 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
- $261.86 / $422.95 / $619.64
| Professional | | $261.86 | $422.95 | $619.64 |