- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.37 / $2,747.00 / $8,017.00
| Facility | | $230.37 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.84 / $257.18 / $522.63
| Professional | | $184.84 | $257.18 | $522.63 |
- 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
- $223.75 / $263.23 / $263.23
| Professional | | $223.75 | $263.23 | $263.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.46 / $303.18 / $476.27
| Professional | | $209.46 | $303.18 | $476.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.99 / $398.56 / $404.93
| Professional | | $300.99 | $398.56 | $404.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,577.69 / $4,908.25 / $9,043.35
| Facility | | $2,577.69 | $4,908.25 | $9,043.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $3,077.00 / $8,017.00
| Facility | | $540.00 | $3,077.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.34 / $280.74 / $684.19
| Professional | | $193.34 | $280.74 | $684.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $270.80 / $667.00
| Professional | | $3.00 | $270.80 | $667.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.54 / $308.14 / $495.52
| Professional | | $212.54 | $308.14 | $495.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $217.79 / $272.33
| Facility | | $194.98 | $217.79 | $272.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $243.58 / $264.72
| Professional | | $194.98 | $243.58 | $264.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,175.00 / $2,824.00 / $4,789.00
| Facility | | $1,175.00 | $2,824.00 | $4,789.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.03 / $319.43 / $528.55
| Professional | | $240.03 | $319.43 | $528.55 |