- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.06 / $2,747.00 / $8,017.00
| Facility | | $190.06 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.25 / $154.38 / $249.93
| Professional | | $125.25 | $154.38 | $249.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,450.00 / $5,951.00 / $8,887.00
| Facility | | $2,450.00 | $5,951.00 | $8,887.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.06 / $206.57 / $252.91
| Professional | | $199.06 | $206.57 | $252.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.19 / $195.72 / $339.24
| Professional | | $139.19 | $195.72 | $339.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.77 / $319.87 / $323.81
| Professional | | $240.77 | $319.87 | $323.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,638.61 / $10,638.61 / $10,638.61
| Facility | | $10,638.61 | $10,638.61 | $10,638.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.00 / $3,077.00 / $8,017.00
| Facility | | $832.00 | $3,077.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.46 / $187.27 / $700.00
| Professional | | $131.46 | $187.27 | $700.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $213.50 / $555.70
| Professional | | $3.00 | $213.50 | $555.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.85 / $206.57 / $339.24
| Professional | | $142.85 | $206.57 | $339.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.88 / $148.83 / $201.12
| Facility | | $143.88 | $148.83 | $201.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.88 / $180.72 / $215.71
| Professional | | $143.88 | $180.72 | $215.71 |
- 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
- $152.10 / $202.95 / $348.44
| Professional | | $152.10 | $202.95 | $348.44 |