- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.62 / $2,070.00 / $7,629.00
| Facility | | $354.62 | $2,070.00 | $7,629.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.25 / $300.20 / $511.37
| Professional | | $150.25 | $300.20 | $511.37 |
- 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
- $257.45 / $370.56 / $523.86
| Professional | | $257.45 | $370.56 | $523.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.87 / $295.13 / $564.15
| Professional | | $148.87 | $295.13 | $564.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.88 / $433.88 / $434.07
| Professional | | $433.88 | $433.88 | $434.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,854.15 / $1,854.15 / $1,854.15
| Facility | | $1,854.15 | $1,854.15 | $1,854.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.58 / $287.25 / $435.99
| Professional | | $147.58 | $287.25 | $435.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $617.00 / $2,371.00 / $8,017.00
| Facility | | $617.00 | $2,371.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.97 / $310.00 / $717.63
| Professional | | $149.97 | $310.00 | $717.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.69 / $279.48 / $715.50
| Professional | | $133.69 | $279.48 | $715.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.10 / $305.51 / $585.13
| Professional | | $150.10 | $305.51 | $585.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.44 / $274.56 / $450.87
| Facility | | $129.44 | $274.56 | $450.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.44 / $268.16 / $294.63
| Professional | | $129.44 | $268.16 | $294.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.00 / $650.00 / $3,742.00
| Facility | | $144.00 | $650.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.37 / $441.33 / $662.64
| Professional | | $296.37 | $441.33 | $662.64 |