- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.12 / $2,675.00 / $8,017.00
| Facility | | $294.12 | $2,675.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.92 / $263.32 / $398.12
| Professional | | $171.92 | $263.32 | $398.12 |
- 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
- $298.58 / $494.71 / $579.71
| Professional | | $298.58 | $494.71 | $579.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.84 / $295.77 / $503.63
| Professional | | $181.84 | $295.77 | $503.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.65 / $462.40 / $478.25
| Professional | | $359.65 | $462.40 | $478.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,045.31 / $8,625.20 / $9,959.09
| Facility | | $7,045.31 | $8,625.20 | $9,959.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $692.40 / $2,675.00 / $8,017.00
| Facility | | $692.40 | $2,675.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.87 / $286.95 / $873.53
| Professional | | $173.87 | $286.95 | $873.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.70 / $331.70 / $331.70
| Professional | | $331.70 | $331.70 | $331.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $329.19 / $329.19 / $329.19
| Facility | | $329.19 | $329.19 | $329.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.93 / $298.02 / $544.45
| Professional | | $190.93 | $298.02 | $544.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.73 / $191.51 / $302.02
| Facility | | $190.73 | $191.51 | $302.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.73 / $265.49 / $322.35
| Professional | | $190.73 | $265.49 | $322.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $3,475.00 / $6,368.00
| Facility | | $2,155.00 | $3,475.00 | $6,368.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.01 / $345.32 / $599.75
| Professional | | $275.01 | $345.32 | $599.75 |