- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $948.48 / $2,083.00 / $3,685.00
| Facility | | $948.48 | $2,083.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.88 / $184.50 / $1,591.67
| Professional | | $141.88 | $184.50 | $1,591.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.24 / $1,007.54 / $7,958.00
| Facility | | $373.24 | $1,007.54 | $7,958.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.02 / $268.49 / $2,046.59
| Professional | | $121.02 | $268.49 | $2,046.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.20 / $281.14 / $458.63
| Professional | | $204.20 | $281.14 | $458.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.38 / $299.04 / $551.41
| Professional | | $173.38 | $299.04 | $551.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $3,472.00 / $9,239.00
| Facility | | $83.43 | $3,472.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.79 / $196.79 / $231.52
| Professional | | $196.79 | $196.79 | $231.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.63 / $360.25 / $527.98
| Professional | | $180.63 | $360.25 | $527.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.50 / $217.50 / $217.50
| Professional | | $217.50 | $217.50 | $217.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $542.48 / $2,510.00 / $12,000.00
| Facility | | $542.48 | $2,510.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.30 / $287.45 / $2,046.59
| Professional | | $138.30 | $287.45 | $2,046.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.00 / $2,408.00 / $7,161.00
| Facility | | $950.00 | $2,408.00 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.26 / $219.52 / $503.59
| Professional | | $124.26 | $219.52 | $503.59 |