- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.08 / $2,791.00 / $7,197.00
| Facility | | $136.08 | $2,791.00 | $7,197.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.23 / $238.69 / $393.64
| Professional | | $121.23 | $238.69 | $393.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.69 / $3,159.00 / $14,886.03
| Facility | | $2,344.69 | $3,159.00 | $14,886.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.16 / $298.00 / $298.00
| Professional | | $287.16 | $298.00 | $298.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.75 / $254.69 / $490.67
| Professional | | $127.75 | $254.69 | $490.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.06 / $465.74 / $480.28
| Professional | | $351.06 | $465.74 | $480.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,453.25 / $3,453.25 / $8,394.85
| Facility | | $3,453.25 | $3,453.25 | $8,394.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.00 / $3,839.00 / $8,017.00
| Facility | | $594.00 | $3,839.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.08 / $295.06 / $857.68
| Professional | | $126.08 | $295.06 | $857.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $182.70 / $842.60
| Professional | | $5.00 | $182.70 | $842.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.54 / $259.33 / $490.67
| Professional | | $134.54 | $259.33 | $490.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.82 / $143.84 / $295.86
| Facility | | $124.82 | $143.84 | $295.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.54 / $222.64 / $321.02
| Professional | | $124.54 | $222.64 | $321.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.00 / $2,391.00 / $4,789.00
| Facility | | $814.00 | $2,391.00 | $4,789.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.69 / $344.94 / $588.36
| Professional | | $221.69 | $344.94 | $588.36 |