- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.00 / $2,266.00 / $7,799.00
| Facility | | $480.00 | $2,266.00 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.91 / $158.82 / $187.28
| Professional | | $130.91 | $158.82 | $187.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.35 / $6,182.00 / $17,094.48
| Facility | | $5,058.35 | $6,182.00 | $17,094.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.53 / $154.13 / $284.05
| Professional | | $148.53 | $154.13 | $284.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.88 / $194.04 / $301.26
| Professional | | $147.88 | $194.04 | $301.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.48 / $230.92 / $233.17
| Professional | | $174.48 | $230.92 | $233.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,826.27 / $4,826.27 / $9,460.94
| Facility | | $4,826.27 | $4,826.27 | $9,460.94 |
- 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
- $130.91 / $162.61 / $1,023.00
| Professional | | $130.91 | $162.61 | $1,023.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $372.10 / $396.90
| Professional | | $3.00 | $372.10 | $396.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.13 / $202.94 / $328.31
| Professional | | $154.13 | $202.94 | $328.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.84 / $143.84 / $346.57
| Facility | | $143.84 | $143.84 | $346.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.99 / $144.00 / $346.57
| Professional | | $139.99 | $144.00 | $346.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,334.00 / $2,824.00 / $5,678.00
| Facility | | $1,334.00 | $2,824.00 | $5,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.30 / $184.26 / $313.32
| Professional | | $148.30 | $184.26 | $313.32 |