- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.32 / $2,067.00 / $3,625.00
| Facility | | $121.32 | $2,067.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.48 / $116.39 / $230.06
| Professional | | $59.48 | $116.39 | $230.06 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $144.25 / $144.25 / $144.25
| Professional | 50 | $144.25 | $144.25 | $144.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.65 / $941.10 / $4,142.00
| Facility | | $141.65 | $941.10 | $4,142.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.73 / $200.07 / $956.60
| Professional | | $76.73 | $200.07 | $956.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.25 / $90.27 / $179.14
| Facility | | $70.25 | $90.27 | $179.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.64 / $205.12 / $414.99
| Professional | | $89.64 | $205.12 | $414.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.37 / $160.87 / $330.71
| Professional | | $82.37 | $160.87 | $330.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $71.89 / $266.58 / $6,679.00
| Facility | | $71.89 | $266.58 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.79 / $188.79 / $260.60
| Professional | | $154.79 | $188.79 | $260.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.09 / $167.33 / $363.81
| Professional | | $81.09 | $167.33 | $363.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.25 / $1,818.00 / $12,000.00
| Facility | | $300.25 | $1,818.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.52 / $284.64 / $1,278.47
| Professional | | $155.52 | $284.64 | $1,278.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.63 / $212.85 / $384.58
| Professional | | $147.63 | $212.85 | $384.58 |