- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $574.00 / $4,186.12 / $9,674.35
| Facility | | $574.00 | $4,186.12 | $9,674.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.54 / $222.76 / $790.00
| Professional | | $180.54 | $222.76 | $790.00 |
- 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
- $198.04 / $205.51 / $205.51
| Professional | | $198.04 | $205.51 | $205.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.94 / $255.13 / $400.03
| Professional | | $191.94 | $255.13 | $400.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.69 / $306.58 / $308.72
| Professional | | $231.69 | $306.58 | $308.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.83 / $5,563.46 / $9,421.29
| Facility | | $2,511.83 | $5,563.46 | $9,421.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.78 / $3,765.00 / $9,674.35
| Facility | | $599.78 | $3,765.00 | $9,674.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.26 / $276.52 / $804.91
| Professional | | $182.26 | $276.52 | $804.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $256.20 / $493.40
| Professional | | $3.00 | $256.20 | $493.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.84 / $257.75 / $420.53
| Professional | | $198.84 | $257.75 | $420.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.81 / $191.81 / $226.14
| Facility | | $191.81 | $191.81 | $226.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.30 / $192.43 / $226.14
| Professional | | $186.30 | $192.43 | $226.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,175.00 / $2,824.00 / $4,815.00
| Facility | | $1,175.00 | $2,824.00 | $4,815.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.52 / $245.71 / $416.36
| Professional | | $189.52 | $245.71 | $416.36 |