- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.62 / $3,839.00 / $8,113.00
| Facility | | $225.62 | $3,839.00 | $8,113.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.83 / $225.62 / $341.42
| Professional | | $191.83 | $225.62 | $341.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,299.82 / $2,746.00 / $13,822.74
| Facility | | $2,299.82 | $2,746.00 | $13,822.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.80 / $246.77 / $364.42
| Professional | | $237.80 | $246.77 | $364.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.87 / $311.58 / $478.73
| Professional | | $228.87 | $311.58 | $478.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.72 / $391.54 / $391.54
| Professional | | $290.72 | $391.54 | $391.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $807.71 / $807.71 / $807.71
| Facility | | $807.71 | $807.71 | $807.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $670.09 / $4,264.00 / $8,247.00
| Facility | | $670.09 | $4,264.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.63 / $280.43 / $670.09
| Professional | | $194.63 | $280.43 | $670.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $302.30 / $587.10
| Professional | | $4.00 | $302.30 | $587.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.87 / $305.82 / $519.38
| Professional | | $228.87 | $305.82 | $519.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $232.77 / $232.77 / $302.16
| Facility | | $232.77 | $232.77 | $302.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.85 / $237.72 / $302.16
| Professional | | $221.85 | $237.72 | $302.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.00 / $577.00 / $3,742.00
| Facility | | $162.00 | $577.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.62 / $293.62 / $476.80
| Professional | | $224.62 | $293.62 | $476.80 |