- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.92 / $2,240.00 / $7,219.76
| Facility | | $175.92 | $2,240.00 | $7,219.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.54 / $179.07 / $312.95
| Professional | | $119.54 | $179.07 | $312.95 |
- 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
- $192.78 / $200.06 / $308.42
| Professional | | $192.78 | $200.06 | $308.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.38 / $211.53 / $350.78
| Professional | | $137.38 | $211.53 | $350.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.25 / $306.37 / $313.26
| Professional | | $231.25 | $306.37 | $313.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,294.82 / $4,989.71 / $10,560.26
| Facility | | $2,294.82 | $4,989.71 | $10,560.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $2,326.00 / $8,017.00
| Facility | | $490.00 | $2,326.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.35 / $192.17 / $473.13
| Professional | | $125.35 | $192.17 | $473.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $303.20 / $514.79
| Professional | | $3.00 | $303.20 | $514.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.63 / $218.25 / $358.11
| Professional | | $139.63 | $218.25 | $358.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $127.27 / $132.13 / $270.33
| Facility | | $127.27 | $132.13 | $270.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.27 / $184.72 / $201.44
| Professional | | $127.27 | $184.72 | $201.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.00 / $2,113.00 / $3,742.00
| Facility | | $814.00 | $2,113.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.49 / $241.20 / $367.80
| Professional | | $179.49 | $241.20 | $367.80 |