- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $284.92 / $2,240.00 / $7,799.00
| Facility | | $284.92 | $2,240.00 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.59 / $243.77 / $429.76
| Professional | | $158.59 | $243.77 | $429.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,824.00 / $4,354.00 / $8,459.92
| Facility | | $1,824.00 | $4,354.00 | $8,459.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.86 / $255.13 / $255.13
| Professional | | $245.86 | $255.13 | $255.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.40 / $268.62 / $448.83
| Professional | | $173.40 | $268.62 | $448.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.06 / $397.75 / $411.64
| Professional | | $300.06 | $397.75 | $411.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,724.80 / $4,763.71 / $7,785.40
| Facility | | $2,724.80 | $4,763.71 | $7,785.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $617.00 / $2,371.00 / $8,017.00
| Facility | | $617.00 | $2,371.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.09 / $268.44 / $689.27
| Professional | | $165.09 | $268.44 | $689.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $154.50 / $719.60
| Professional | | $5.00 | $154.50 | $719.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.06 / $269.45 / $471.73
| Professional | | $175.06 | $269.45 | $471.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.28 / $160.37 / $249.21
| Facility | | $130.28 | $160.37 | $249.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.88 / $191.76 / $270.36
| Professional | | $157.88 | $191.76 | $270.36 |
- 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
- $218.15 / $310.98 / $516.91
| Professional | | $218.15 | $310.98 | $516.91 |