- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.80 / $2,557.25 / $7,263.00
| Facility | | $132.80 | $2,557.25 | $7,263.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.08 / $101.73 / $185.47
| Professional | | $78.08 | $101.73 | $185.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,800.00 / $7,463.00 / $11,048.00
| Facility | | $2,800.00 | $7,463.00 | $11,048.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.06 / $167.08 / $245.52
| Professional | | $129.06 | $167.08 | $245.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.60 / $138.03 / $240.87
| Professional | | $89.60 | $138.03 | $240.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.20 / $236.58 / $241.98
| Professional | | $178.20 | $236.58 | $241.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,583.66 / $6,455.74 / $15,516.76
| Facility | | $2,583.66 | $6,455.74 | $15,516.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.88 / $3,623.00 / $8,017.00
| Facility | | $142.88 | $3,623.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.70 / $134.50 / $293.83
| Professional | | $81.70 | $134.50 | $293.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $132.19 / $422.10
| Professional | | $4.00 | $132.19 | $422.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.04 / $141.63 / $241.02
| Professional | | $91.04 | $141.63 | $241.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.66 / $93.30 / $149.88
| Facility | | $80.66 | $93.30 | $149.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.08 / $114.60 / $161.91
| Professional | | $91.08 | $114.60 | $161.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $5,762.00 / $15,888.49
| Facility | | $2,332.00 | $5,762.00 | $15,888.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.44 / $152.60 / $264.27
| Professional | | $105.44 | $152.60 | $264.27 |