- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $227.26 / $3,839.00 / $8,247.00
| Facility | | $227.26 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.64 / $227.26 / $1,431.77
| Professional | | $184.64 | $227.26 | $1,431.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,531.00 / $27,840.00 / $46,480.74
| Facility | | $13,531.00 | $27,840.00 | $46,480.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.20 / $591.71 / $591.71
| Professional | | $570.20 | $591.71 | $591.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.36 / $284.30 / $419.52
| Professional | | $210.36 | $284.30 | $419.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.70 / $281.27 / $630.85
| Professional | | $219.70 | $281.27 | $630.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.00 / $4,761.00 / $8,247.00
| Facility | | $657.00 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.64 / $278.77 / $1,582.60
| Professional | | $184.64 | $278.77 | $1,582.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.80 / $201.80 / $221.00
| Professional | | $201.80 | $201.80 | $221.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.55 / $284.30 / $504.87
| Professional | | $216.55 | $284.30 | $504.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.69 / $557.53 / $557.53
| Facility | | $537.69 | $557.53 | $557.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.32 / $545.98 / $557.53
| Professional | | $171.32 | $545.98 | $557.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.00 / $2,391.00 / $6,322.00
| Facility | | $625.00 | $2,391.00 | $6,322.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.40 / $672.40 / $1,137.65
| Professional | | $172.40 | $672.40 | $1,137.65 |