- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.14 / $1,901.00 / $7,175.00
| Facility | | $119.14 | $1,901.00 | $7,175.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.88 / $117.32 / $233.75
| Professional | | $78.88 | $117.32 | $233.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.51 / $242.51 / $242.51
| Professional | | $242.51 | $242.51 | $242.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $2,594.00 / $5,296.01
| Facility | | $680.00 | $2,594.00 | $5,296.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.44 / $190.76 / $259.06
| Professional | | $131.44 | $190.76 | $259.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.74 / $142.60 / $239.89
| Professional | | $95.74 | $142.60 | $239.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.80 / $209.69 / $210.55
| Professional | | $157.80 | $209.69 | $210.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.23 / $609.39 / $1,194.84
| Facility | | $65.23 | $609.39 | $1,194.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $484.32 / $2,070.00 / $7,799.00
| Facility | | $484.32 | $2,070.00 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.56 / $132.12 / $297.43
| Professional | | $83.56 | $132.12 | $297.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $153.10 / $344.50
| Professional | | $3.00 | $153.10 | $344.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.07 / $148.80 / $242.07
| Professional | | $99.07 | $148.80 | $242.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.50 / $102.79 / $130.54
| Facility | | $87.50 | $102.79 | $130.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.50 / $126.07 / $137.60
| Professional | | $87.50 | $126.07 | $137.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $364.00 / $674.00 / $3,000.00
| Facility | | $364.00 | $674.00 | $3,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.22 / $159.36 / $266.33
| Professional | | $119.22 | $159.36 | $266.33 |