- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $180.60 / $1,633.00 / $7,175.00
| Facility | | $180.60 | $1,633.00 | $7,175.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.30 / $153.18 / $231.23
| Professional | | $105.30 | $153.18 | $231.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,083.51 / $1,395.00 / $12,759.45
| Facility | | $1,083.51 | $1,395.00 | $12,759.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.55 / $196.20 / $289.61
| Professional | | $133.55 | $196.20 | $289.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.43 / $172.62 / $280.81
| Professional | | $114.43 | $172.62 | $280.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.73 / $239.73 / $241.58
| Professional | | $239.73 | $239.73 | $241.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,234.04 / $1,638.91 / $1,681.88
| Facility | | $1,234.04 | $1,638.91 | $1,681.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.76 / $121.76 / $196.51
| Professional | | $121.76 | $121.76 | $196.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $276.20 / $1,819.00 / $7,197.00
| Facility | | $276.20 | $1,819.00 | $7,197.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.25 / $178.27 / $600.64
| Professional | | $110.25 | $178.27 | $600.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $225.40 / $388.10
| Professional | | $6.00 | $225.40 | $388.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.31 / $172.69 / $272.77
| Professional | | $117.31 | $172.69 | $272.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.92 / $129.13 / $201.06
| Facility | | $100.92 | $129.13 | $201.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.92 / $129.13 / $156.54
| Professional | | $100.92 | $129.13 | $156.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $582.00 / $1,490.72 / $3,211.00
| Facility | | $582.00 | $1,490.72 | $3,211.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.96 / $200.81 / $305.02
| Professional | | $147.96 | $200.81 | $305.02 |