- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $282.04 / $2,240.00 / $7,984.48
| Facility | | $282.04 | $2,240.00 | $7,984.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.63 / $268.22 / $740.48
| Professional | | $161.63 | $268.22 | $740.48 |
- 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
- $269.95 / $280.14 / $280.14
| Professional | | $269.95 | $280.14 | $280.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.88 / $302.22 / $465.32
| Professional | | $193.88 | $302.22 | $465.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.58 / $434.53 / $445.45
| Professional | | $327.58 | $434.53 | $445.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.75 / $2,340.44 / $4,995.57
| Facility | | $570.75 | $2,340.44 | $4,995.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $299.85 / $1,819.00 / $7,175.00
| Facility | | $299.85 | $1,819.00 | $7,175.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.53 / $281.63 / $852.54
| Professional | | $139.53 | $281.63 | $852.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $221.40 / $753.60
| Professional | | $5.00 | $221.40 | $753.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.56 / $309.93 / $490.22
| Professional | | $201.56 | $309.93 | $490.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.49 / $198.58 / $277.44
| Facility | | $182.49 | $198.58 | $277.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.54 / $266.61 / $292.20
| Professional | | $194.54 | $266.61 | $292.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.00 / $2,391.00 / $4,789.00
| Facility | | $814.00 | $2,391.00 | $4,789.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.02 / $333.07 / $535.80
| Professional | | $222.02 | $333.07 | $535.80 |