- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.63 / $1,926.00 / $7,175.00
| Facility | | $153.63 | $1,926.00 | $7,175.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.85 / $121.43 / $387.61
| Professional | | $90.85 | $121.43 | $387.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,122.56 / $2,838.15 / $6,846.16
| Facility | | $2,122.56 | $2,838.15 | $6,846.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.86 / $154.47 / $224.93
| Professional | | $148.86 | $154.47 | $224.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.75 / $144.65 / $245.82
| Professional | | $101.75 | $144.65 | $245.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.02 / $240.43 / $244.96
| Professional | | $181.02 | $240.43 | $244.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,062.93 / $2,913.47 / $4,021.47
| Facility | | $1,062.93 | $2,913.47 | $4,021.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $379.00 / $1,978.00 / $7,197.00
| Facility | | $379.00 | $1,978.00 | $7,197.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.51 / $160.88 / $425.74
| Professional | | $94.51 | $160.88 | $425.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $134.69 / $422.10
| Professional | | $3.00 | $134.69 | $422.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.22 / $149.43 / $251.29
| Professional | | $103.22 | $149.43 | $251.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.61 / $106.55 / $150.81
| Facility | | $92.61 | $106.55 | $150.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.12 / $116.50 / $162.54
| Professional | | $104.12 | $116.50 | $162.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.00 / $1,305.00 / $3,742.00
| Facility | | $471.00 | $1,305.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.57 / $146.79 / $255.47
| Professional | | $106.57 | $146.79 | $255.47 |