- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.58 / $1,886.00 / $3,693.00
| Facility | | $153.58 | $1,886.00 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.93 / $155.54 / $376.69
| Professional | | $69.93 | $155.54 | $376.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.98 / $818.35 / $2,733.00
| Facility | | $165.98 | $818.35 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.81 / $292.72 / $858.90
| Professional | | $79.81 | $292.72 | $858.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.41 / $99.47 / $197.78
| Facility | | $77.41 | $99.47 | $197.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.50 / $204.81 / $408.80
| Professional | | $104.50 | $204.81 | $408.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.07 / $186.22 / $514.15
| Professional | | $92.07 | $186.22 | $514.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.66 / $168.26 / $6,679.00
| Facility | | $79.66 | $168.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.95 / $252.09 / $440.44
| Professional | | $194.95 | $252.09 | $440.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.98 / $208.08 / $460.90
| Professional | | $97.98 | $208.08 | $460.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $567.02 / $567.02 / $567.02
| Facility | | $567.02 | $567.02 | $567.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.94 / $110.68 / $415.61
| Professional | | $107.94 | $110.68 | $415.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $947.00 / $2,796.00
| Facility | | $308.00 | $947.00 | $2,796.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.44 / $417.00 / $1,209.44
| Professional | | $223.44 | $417.00 | $1,209.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,790.00 / $2,796.00
| Facility | | $627.00 | $1,790.00 | $2,796.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.01 / $334.97 / $753.60
| Professional | | $208.01 | $334.97 | $753.60 |