- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $205.53 / $1,926.00 / $7,197.00
| Facility | | $205.53 | $1,926.00 | $7,197.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.13 / $178.92 / $241.66
| Professional | | $147.13 | $178.92 | $241.66 |
- 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
- $189.11 / $196.25 / $303.47
| Professional | | $189.11 | $196.25 | $303.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.33 / $225.69 / $353.86
| Professional | | $172.33 | $225.69 | $353.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.11 / $300.77 / $300.77
| Professional | | $226.11 | $300.77 | $300.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,809.32 / $5,809.32 / $5,809.32
| Facility | | $5,809.32 | $5,809.32 | $5,809.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $2,070.00 / $7,799.00
| Facility | | $490.00 | $2,070.00 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.13 / $186.56 / $869.81
| Professional | | $147.13 | $186.56 | $869.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $336.00 / $482.70
| Professional | | $4.00 | $336.00 | $482.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.01 / $233.51 / $379.41
| Professional | | $177.01 | $233.51 | $379.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.82 / $185.27 / $318.72
| Facility | | $162.82 | $185.27 | $318.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.82 / $179.97 / $204.41
| Professional | | $162.82 | $179.97 | $204.41 |
- 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
- $174.74 / $231.57 / $371.93
| Professional | | $174.74 | $231.57 | $371.93 |