- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $187.86 / $1,338.00 / $8,413.00
| Facility | | $187.86 | $1,338.00 | $8,413.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.53 / $193.58 / $328.37
| Professional | | $184.53 | $193.58 | $328.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,506.47 / $1,657.11 / $2,812.07
| Facility | | $1,506.47 | $1,657.11 | $2,812.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.17 / $324.98 / $518.49
| Professional | | $221.17 | $324.98 | $518.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.36 / $1,359.55 / $2,702.90
| Facility | | $495.36 | $1,359.55 | $2,702.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.65 / $284.67 / $478.11
| Professional | | $206.65 | $284.67 | $478.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $187.86 / $246.67 / $349.73
| Facility | | $187.86 | $246.67 | $349.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.00 / $606.00 / $1,474.06
| Professional | | $268.00 | $606.00 | $1,474.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.10 / $272.89 / $428.10
| Professional | | $230.10 | $272.89 | $428.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.00 / $1,208.00 / $9,324.00
| Facility | | $773.00 | $1,208.00 | $9,324.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.83 / $228.17 / $455.46
| Professional | | $164.83 | $228.17 | $455.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,093.44 / $7,909.30 / $26,542.00
| Facility | | $1,093.44 | $7,909.30 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,429.92 / $1,429.92 / $1,669.95
| Professional | | $1,429.92 | $1,429.92 | $1,669.95 |