- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.32 / $2,070.00 / $7,629.00
| Facility | | $108.32 | $2,070.00 | $7,629.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.99 / $96.60 / $128.02
| Professional | | $43.99 | $96.60 | $128.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,299.82 / $2,746.00 / $13,822.74
| Facility | | $2,299.82 | $2,746.00 | $13,822.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.77 / $141.16 / $214.75
| Professional | | $88.77 | $141.16 | $214.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.87 / $107.90 / $214.17
| Professional | | $52.87 | $107.90 | $214.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.71 / $159.77 / $164.29
| Professional | | $120.71 | $159.77 | $164.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,186.41 / $1,186.41 / $3,750.60
| Facility | | $1,186.41 | $1,186.41 | $3,750.60 |
- 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
- $44.92 / $98.06 / $294.02
| Professional | | $44.92 | $98.06 | $294.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $107.80 / $287.39
| Professional | | $3.00 | $107.80 | $287.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.12 / $111.54 / $215.00
| Professional | | $53.12 | $111.54 | $215.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.32 / $58.05 / $114.19
| Facility | | $47.32 | $58.05 | $114.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.32 / $102.19 / $111.52
| Professional | | $47.32 | $102.19 | $111.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $435.00 / $1,305.00 / $3,742.00
| Facility | | $435.00 | $1,305.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.47 / $128.16 / $220.81
| Professional | | $100.47 | $128.16 | $220.81 |