- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.62 / $2,747.00 / $8,017.00
| Facility | | $115.62 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.09 / $94.88 / $143.26
| Professional | | $70.09 | $94.88 | $143.26 |
- 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
- $121.66 / $126.25 / $166.98
| Professional | | $121.66 | $126.25 | $166.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.43 / $124.75 / $219.21
| Professional | | $86.43 | $124.75 | $219.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.94 / $193.91 / $194.69
| Professional | | $145.94 | $193.91 | $194.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,593.75 / $18,593.75 / $18,593.75
| Facility | | $18,593.75 | $18,593.75 | $18,593.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $918.00 / $3,077.00 / $8,017.00
| Facility | | $918.00 | $3,077.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.45 / $112.90 / $425.00
| Professional | | $70.45 | $112.90 | $425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $139.69 / $334.40
| Professional | | $3.00 | $139.69 | $334.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.15 / $126.59 / $221.24
| Professional | | $87.15 | $126.59 | $221.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.11 / $82.50 / $123.32
| Facility | | $78.11 | $82.50 | $123.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.11 / $116.10 / $131.38
| Professional | | $78.11 | $116.10 | $131.38 |
- 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
- $98.63 / $132.29 / $218.78
| Professional | | $98.63 | $132.29 | $218.78 |