- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $201.22 / $3,570.00 / $7,951.32
| Facility | | $201.22 | $3,570.00 | $7,951.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.06 / $111.45 / $161.19
| Professional | | $101.06 | $111.45 | $161.19 |
- 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
- $85.34 / $100.40 / $177.15
| Professional | | $85.34 | $100.40 | $177.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.40 / $149.75 / $272.76
| Professional | | $100.40 | $149.75 | $272.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.88 / $150.97 / $151.06
| Professional | | $113.88 | $150.97 | $151.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,027.08 / $4,139.79 / $6,939.70
| Facility | | $1,027.08 | $4,139.79 | $6,939.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $534.23 / $3,654.00 / $8,017.00
| Facility | | $534.23 | $3,654.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.74 / $117.78 / $349.80
| Professional | | $95.74 | $117.78 | $349.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.10 / $283.10 / $283.10
| Professional | | $283.10 | $283.10 | $283.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.09 / $154.40 / $292.80
| Professional | | $107.09 | $154.40 | $292.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.81 / $93.81 / $122.60
| Facility | | $93.81 | $93.81 | $122.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.99 / $94.23 / $122.60
| Professional | | $90.99 | $94.23 | $122.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.00 / $577.00 / $3,742.00
| Facility | | $162.00 | $577.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.84 / $148.76 / $230.61
| Professional | | $107.84 | $148.76 | $230.61 |