- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $299.35 / $2,070.00 / $7,629.00
| Facility | | $299.35 | $2,070.00 | $7,629.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.42 / $203.86 / $386.18
| Professional | | $113.42 | $203.86 | $386.18 |
- 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
- $255.42 / $265.06 / $404.08
| Professional | | $255.42 | $265.06 | $404.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.52 / $232.86 / $428.25
| Professional | | $121.52 | $232.86 | $428.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.06 / $414.04 / $426.49
| Professional | | $312.06 | $414.04 | $426.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,059.92 / $1,059.92 / $1,081.08
| Facility | | $1,059.92 | $1,059.92 | $1,081.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.00 / $2,326.00 / $8,017.00
| Facility | | $594.00 | $2,326.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.13 / $253.57 / $758.75
| Professional | | $116.13 | $253.57 | $758.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $174.20 / $745.10
| Professional | | $5.00 | $174.20 | $745.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.35 / $241.48 / $444.21
| Professional | | $127.35 | $241.48 | $444.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.29 / $119.51 / $262.73
| Facility | | $110.29 | $119.51 | $262.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.64 / $148.26 / $284.89
| Professional | | $116.64 | $148.26 | $284.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.00 / $577.00 / $3,742.00
| Facility | | $162.00 | $577.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.76 / $286.02 / $505.47
| Professional | | $181.76 | $286.02 | $505.47 |