- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $2,089.30 / $3,801.89
| Facility | | $107.15 | $2,089.30 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $158.49 / $380.19
| Professional | | $79.43 | $158.49 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,288.25 / $3,801.89
| Facility | | $56.23 | $1,288.25 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $169.82 / $416.87
| Professional | | $97.72 | $169.82 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $239.88
| Facility | | $104.71 | $104.71 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $165.96 / $245.47
| Professional | | $100.00 | $165.96 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $177.83 / $354.81
| Professional | | $102.33 | $177.83 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.28 / $177.83 / $7,079.46
| Facility | | $81.28 | $177.83 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $194.98 / $288.40
| Professional | | $151.36 | $194.98 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,511.89 / $7,079.46
| Facility | | $1,096.48 | $2,511.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $177.83 / $380.19
| Professional | | $97.72 | $177.83 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $537.03 / $537.03
| Facility | | $537.03 | $537.03 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,288.25 / $3,801.89
| Facility | | $56.23 | $1,288.25 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $169.82 / $426.58
| Professional | | $97.72 | $169.82 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,344.23 / $6,165.95
| Facility | | $954.99 | $2,344.23 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $177.83 / $338.84
| Professional | | $100.00 | $177.83 | $338.84 |