- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $145.18 / $2,070.00 / $7,629.00
| Facility | | $145.18 | $2,070.00 | $7,629.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.42 / $120.95 / $237.28
| Professional | | $60.42 | $120.95 | $237.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,122.56 / $2,594.00 / $5,296.01
| Facility | | $2,122.56 | $2,594.00 | $5,296.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.59 / $235.02 / $286.93
| Professional | | $125.59 | $235.02 | $286.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.12 / $143.87 / $275.16
| Professional | | $74.12 | $143.87 | $275.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.92 / $231.72 / $232.44
| Professional | | $173.92 | $231.72 | $232.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.10 / $164.10 / $164.10
| Professional | | $164.10 | $164.10 | $164.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.00 / $2,326.00 / $8,017.00
| Facility | | $594.00 | $2,326.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.79 / $136.37 / $431.18
| Professional | | $60.79 | $136.37 | $431.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.80 / $182.20 / $307.20
| Professional | | $69.80 | $182.20 | $307.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.81 / $149.22 / $275.16
| Professional | | $74.81 | $149.22 | $275.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.42 / $87.48 / $146.15
| Facility | | $67.42 | $87.48 | $146.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.42 / $134.15 / $157.26
| Professional | | $67.42 | $134.15 | $157.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.00 / $2,391.00 / $4,789.00
| Facility | | $814.00 | $2,391.00 | $4,789.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.99 / $174.72 / $299.95
| Professional | | $114.99 | $174.72 | $299.95 |