- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $197.84 / $1,777.00 / $6,012.00
| Facility | | $197.84 | $1,777.00 | $6,012.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.24 / $206.74 / $345.63
| Professional | | $155.24 | $206.74 | $345.63 |
- 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
- $221.66 / $230.02 / $396.09
| Professional | | $221.66 | $230.02 | $396.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.66 / $252.55 / $411.23
| Professional | | $176.66 | $252.55 | $411.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.52 / $350.13 / $358.41
| Professional | | $264.52 | $350.13 | $358.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,484.01 / $6,484.01 / $7,911.66
| Facility | | $6,484.01 | $6,484.01 | $7,911.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $2,266.00 / $7,799.00
| Facility | | $490.00 | $2,266.00 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.38 / $230.48 / $474.15
| Professional | | $162.38 | $230.48 | $474.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $343.40 / $578.00
| Professional | | $3.00 | $343.40 | $578.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.89 / $257.66 / $418.79
| Professional | | $180.89 | $257.66 | $418.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.62 / $192.42 / $282.11
| Facility | | $166.62 | $192.42 | $282.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.31 / $211.10 / $229.70
| Professional | | $166.31 | $211.10 | $229.70 |
- 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
- $198.93 / $268.62 / $430.13
| Professional | | $198.93 | $268.62 | $430.13 |