- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.47 / $2,663.12 / $5,039.00
| Facility | | $170.47 | $2,663.12 | $5,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.93 / $129.96 / $316.32
| Professional | | $97.93 | $129.96 | $316.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $296.12 / $3,997.00 / $12,379.00
| Facility | | $296.12 | $3,997.00 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.62 / $231.52 / $862.64
| Professional | | $121.62 | $231.52 | $862.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.69 / $239.57 / $344.25
| Professional | | $170.69 | $239.57 | $344.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.41 / $253.22 / $458.94
| Professional | | $169.41 | $253.22 | $458.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $122.20 / $300.00 / $6,679.00
| Facility | | $122.20 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.47 / $173.71 / $310.58
| Professional | | $137.47 | $173.71 | $310.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.05 / $293.27 / $390.86
| Professional | | $147.05 | $293.27 | $390.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,848.42 / $4,122.47 / $5,134.35
| Facility | | $1,848.42 | $4,122.47 | $5,134.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.06 / $96.45 / $105.55
| Professional | | $94.06 | $96.45 | $105.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $4,525.00 / $26,542.00
| Facility | | $1,061.00 | $4,525.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.59 / $259.82 / $862.64
| Professional | | $142.59 | $259.82 | $862.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.80 / $193.40 / $420.14
| Professional | | $137.80 | $193.40 | $420.14 |