- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $355.23 / $2,805.36 / $7,175.00
| Facility | | $355.23 | $2,805.36 | $7,175.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.25 / $285.56 / $598.64
| Professional | | $149.25 | $285.56 | $598.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,450.00 / $5,951.00 / $8,887.00
| Facility | | $2,450.00 | $5,951.00 | $8,887.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.33 / $305.45 / $632.88
| Professional | | $294.33 | $305.45 | $632.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.82 / $284.25 / $502.04
| Professional | | $160.82 | $284.25 | $502.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.00 / $254.38 / $469.39
| Professional | | $96.00 | $254.38 | $469.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,246.80 / $4,326.97 / $8,278.42
| Facility | | $2,246.80 | $4,326.97 | $8,278.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.00 / $3,299.38 / $7,799.00
| Facility | | $316.00 | $3,299.38 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.25 / $303.54 / $668.36
| Professional | | $149.25 | $303.54 | $668.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $648.29 / $857.10
| Professional | | $3.00 | $648.29 | $857.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.47 / $295.29 / $535.73
| Professional | | $163.47 | $295.29 | $535.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.12 / $192.33 / $308.00
| Facility | | $146.12 | $192.33 | $308.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.12 / $297.02 / $330.78
| Professional | | $146.12 | $297.02 | $330.78 |
- 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
- $256.33 / $350.09 / $572.37
| Professional | | $256.33 | $350.09 | $572.37 |