- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.01 / $3,633.00 / $8,294.00
| Facility | | $243.01 | $3,633.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.55 / $791.49 / $1,334.84
| Professional | | $219.55 | $791.49 | $1,334.84 |
- 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
- $196.57 / $772.36 / $1,516.81
| Professional | | $196.57 | $772.36 | $1,516.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.98 / $205.98 / $880.71
| Professional | | $205.98 | $205.98 | $880.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $336.96 / $336.96 / $336.96
| Facility | | $336.96 | $336.96 | $336.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.44 / $547.94 / $1,898.56
| Professional | | $227.44 | $547.94 | $1,898.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $905.81 / $1,086.97 / $1,332.08
| Professional | | $905.81 | $1,086.97 | $1,332.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.70 / $1,084.65 / $1,901.10
| Facility | | $236.70 | $1,084.65 | $1,901.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,269.00 / $1,446.00 / $2,265.00
| Professional | | $1,269.00 | $1,446.00 | $2,265.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.73 / $289.39 / $860.17
| Facility | | $208.73 | $289.39 | $860.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,108.20 / $1,537.07 / $2,493.08
| Professional | | $1,108.20 | $1,537.07 | $2,493.08 |
- 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
- $946.84 / $1,469.50 / $2,286.25
| Professional | | $946.84 | $1,469.50 | $2,286.25 |