- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $233.35 / $2,679.00 / $8,017.00
| Facility | | $233.35 | $2,679.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.59 / $173.73 / $268.02
| Professional | | $122.59 | $173.73 | $268.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.35 / $6,182.00 / $17,094.48
| Facility | | $5,058.35 | $6,182.00 | $17,094.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.51 / $219.09 / $219.09
| Professional | | $197.51 | $219.09 | $219.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.32 / $211.17 / $370.97
| Professional | | $136.32 | $211.17 | $370.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.34 / $337.36 / $343.81
| Professional | | $254.34 | $337.36 | $343.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,225.87 / $13,225.87 / $13,225.87
| Facility | | $13,225.87 | $13,225.87 | $13,225.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.00 / $2,679.00 / $8,017.00
| Facility | | $760.00 | $2,679.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.59 / $206.38 / $934.00
| Professional | | $122.59 | $206.38 | $934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $230.10 / $571.79
| Professional | | $6.00 | $230.10 | $571.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.43 / $220.41 / $394.18
| Professional | | $139.43 | $220.41 | $394.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.05 / $126.16 / $210.89
| Facility | | $119.05 | $126.16 | $210.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.45 / $184.86 / $226.09
| Professional | | $122.45 | $184.86 | $226.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,334.00 / $2,824.00 / $5,678.00
| Facility | | $1,334.00 | $2,824.00 | $5,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.78 / $250.78 / $415.83
| Professional | | $178.78 | $250.78 | $415.83 |