- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $322.47 / $2,747.00 / $8,017.00
| Facility | | $322.47 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.43 / $278.63 / $409.83
| Professional | | $193.43 | $278.63 | $409.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,299.82 / $2,746.00 / $13,822.74
| Facility | | $2,299.82 | $2,746.00 | $13,822.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.16 / $549.29 / $593.72
| Professional | | $334.16 | $549.29 | $593.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.40 / $326.48 / $536.04
| Professional | | $209.40 | $326.48 | $536.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.03 / $516.90 / $534.53
| Professional | | $402.03 | $516.90 | $534.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $918.00 / $3,389.00 / $8,017.00
| Facility | | $918.00 | $3,389.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.89 / $306.85 / $1,183.70
| Professional | | $195.89 | $306.85 | $1,183.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.80 / $319.80 / $331.50
| Professional | | $319.80 | $319.80 | $331.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $378.97 / $378.97 / $378.97
| Facility | | $378.97 | $378.97 | $378.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.26 / $330.46 / $564.05
| Professional | | $219.26 | $330.46 | $564.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $198.46 / $218.67 / $335.34
| Facility | | $198.46 | $218.67 | $335.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.65 / $268.11 / $357.56
| Professional | | $210.65 | $268.11 | $357.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.00 / $2,391.00 / $6,000.00
| Facility | | $814.00 | $2,391.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.69 / $359.38 / $672.72
| Professional | | $285.69 | $359.38 | $672.72 |