- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.08 / $3,226.00 / $8,294.00
| Facility | | $182.08 | $3,226.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.10 / $910.51 / $1,545.61
| Professional | | $131.10 | $910.51 | $1,545.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,032.00 / $6,548.00 / $7,221.00
| Facility | | $5,032.00 | $6,548.00 | $7,221.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.92 / $137.16 / $228.50
| Professional | | $104.92 | $137.16 | $228.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.50 / $310.64 / $6,694.00
| Professional | | $130.50 | $310.64 | $6,694.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.00 / $176.00 / $176.00
| Facility | | $176.00 | $176.00 | $176.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.50 / $871.58 / $1,890.76
| Professional | | $130.50 | $871.58 | $1,890.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,074.27 / $1,263.84 / $1,579.81
| Professional | | $1,074.27 | $1,263.84 | $1,579.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.10 / $1,040.95 / $1,939.37
| Facility | | $131.10 | $1,040.95 | $1,939.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,386.00 / $1,621.93 / $2,229.00
| Professional | | $1,386.00 | $1,621.93 | $2,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.88 / $326.66 / $9,210.00
| Facility | | $141.88 | $326.66 | $9,210.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,116.59 / $1,511.96 / $9,210.00
| Professional | | $1,116.59 | $1,511.96 | $9,210.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,270.00 / $17,192.00
| Facility | | $6,303.00 | $9,270.00 | $17,192.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $923.72 / $1,276.72 / $2,223.07
| Professional | | $923.72 | $1,276.72 | $2,223.07 |