- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.37 / $2,679.00 / $8,017.00
| Facility | | $292.37 | $2,679.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.82 / $188.85 / $337.04
| Professional | | $112.82 | $188.85 | $337.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,431.95 / $7,827.00 / $19,139.18
| Facility | | $6,431.95 | $7,827.00 | $19,139.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.31 / $269.08 / $465.79
| Professional | | $259.31 | $269.08 | $465.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.38 / $235.05 / $445.94
| Professional | | $128.38 | $235.05 | $445.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.39 / $418.52 / $428.90
| Professional | | $315.39 | $418.52 | $428.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,158.48 / $3,158.48 / $3,182.24
| Facility | | $3,158.48 | $3,158.48 | $3,182.24 |
- 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
- $114.20 / $224.85 / $625.66
| Professional | | $114.20 | $224.85 | $625.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $210.50 / $723.90
| Professional | | $6.00 | $210.50 | $723.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.58 / $251.67 / $467.89
| Professional | | $129.58 | $251.67 | $467.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.98 / $151.06 / $260.77
| Facility | | $115.98 | $151.06 | $260.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.98 / $234.48 / $281.52
| Professional | | $115.98 | $234.48 | $281.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,214.00 / $2,804.21 / $5,859.84
| Facility | | $1,214.00 | $2,804.21 | $5,859.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.82 / $301.91 / $525.45
| Professional | | $207.82 | $301.91 | $525.45 |