- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.23 / $2,671.00 / $4,806.64
| Facility | | $103.23 | $2,671.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.23 / $127.74 / $190.16
| Professional | | $103.23 | $127.74 | $190.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.13 / $691.86 / $2,713.00
| Facility | | $225.13 | $691.86 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.94 / $168.92 / $818.01
| Professional | | $86.94 | $168.92 | $818.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.88 / $154.31 / $272.70
| Facility | | $118.88 | $154.31 | $272.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.21 / $212.68 / $285.55
| Professional | | $151.21 | $212.68 | $285.55 |
- 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
- $103.42 / $203.72 / $377.02
| Professional | | $103.42 | $203.72 | $377.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.53 / $214.32 / $6,679.00
| Facility | | $102.53 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.01 / $158.93 / $219.38
| Professional | | $127.01 | $158.93 | $219.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.70 / $251.04 / $350.93
| Professional | | $123.70 | $251.04 | $350.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.00 / $250.00 / $250.00
| Professional | | $250.00 | $250.00 | $250.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $966.90 / $3,445.00
| Facility | | $55.00 | $966.90 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.84 / $217.44 / $2,278.08
| Professional | | $118.84 | $217.44 | $2,278.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $1,790.00 / $2,733.00
| Facility | | $500.00 | $1,790.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.60 / $160.33 / $377.99
| Professional | | $115.60 | $160.33 | $377.99 |