- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $88.15 / $1,886.00 / $3,625.00
| Facility | | $88.15 | $1,886.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.90 / $88.15 / $177.64
| Professional | | $34.90 | $88.15 | $177.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.64 / $1,251.81 / $3,804.00
| Facility | | $105.64 | $1,251.81 | $3,804.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.01 / $159.88 / $745.52
| Professional | | $55.01 | $159.88 | $745.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.75 / $71.18 / $139.61
| Facility | | $54.75 | $71.18 | $139.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.28 / $109.28 / $249.14
| Professional | | $109.28 | $109.28 | $249.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $50.00 / $50.00
| Facility | | $50.00 | $50.00 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.93 / $175.26 / $356.47
| Professional | | $84.93 | $175.26 | $356.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.14 / $168.26 / $6,679.00
| Facility | | $56.14 | $168.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.12 / $150.52 / $269.13
| Professional | | $119.12 | $150.52 | $269.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.45 / $130.63 / $281.00
| Professional | | $60.45 | $130.63 | $281.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.56 / $142.56 / $142.56
| Facility | | $142.56 | $142.56 | $142.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,878.00 / $7,161.00
| Facility | | $55.00 | $1,878.00 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.80 / $275.38 / $745.52
| Professional | | $134.80 | $275.38 | $745.52 |
- 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
- $132.82 / $169.94 / $380.26
| Professional | | $132.82 | $169.94 | $380.26 |