- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.35 / $2,747.00 / $8,017.00
| Facility | | $228.35 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.60 / $197.62 / $260.64
| Professional | | $163.60 | $197.62 | $260.64 |
- 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
- $212.52 / $220.54 / $397.18
| Professional | | $212.52 | $220.54 | $397.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.73 / $257.91 / $392.89
| Professional | | $195.73 | $257.91 | $392.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.75 / $332.04 / $335.54
| Professional | | $250.75 | $332.04 | $335.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,316.94 / $9,769.84 / $17,586.93
| Facility | | $2,316.94 | $9,769.84 | $17,586.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $918.00 / $3,120.00 / $8,017.00
| Facility | | $918.00 | $3,120.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.64 / $210.76 / $970.10
| Professional | | $165.64 | $210.76 | $970.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $359.40 / $538.00
| Professional | | $4.00 | $359.40 | $538.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.49 / $261.56 / $407.64
| Professional | | $200.49 | $261.56 | $407.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $179.73 / $205.66 / $363.51
| Facility | | $179.73 | $205.66 | $363.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.73 / $200.38 / $218.03
| Professional | | $179.73 | $200.38 | $218.03 |
- 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
- $194.24 / $262.06 / $438.88
| Professional | | $194.24 | $262.06 | $438.88 |