- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.98 / $3,964.00 / $8,240.00
| Facility | | $332.98 | $3,964.00 | $8,240.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.69 / $296.01 / $393.93
| Professional | | $237.69 | $296.01 | $393.93 |
- 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
- $299.14 / $310.44 / $554.50
| Professional | | $299.14 | $310.44 | $554.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.00 / $358.00 / $358.00
| Facility | | $358.00 | $358.00 | $358.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.89 / $298.55 / $484.07
| Professional | | $219.89 | $298.55 | $484.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.41 / $362.41 / $467.33
| Professional | | $362.41 | $362.41 | $467.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $976.00 / $4,761.00 / $8,247.00
| Facility | | $976.00 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.09 / $311.73 / $1,930.20
| Professional | | $240.09 | $311.73 | $1,930.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.80 / $339.80 / $339.80
| Professional | | $339.80 | $339.80 | $339.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.00 / $358.00 / $358.00
| Facility | | $358.00 | $358.00 | $358.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.89 / $299.06 / $484.07
| Professional | | $219.89 | $299.06 | $484.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.39 / $272.30 / $323.63
| Facility | | $238.39 | $272.30 | $323.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.39 / $289.92 / $323.63
| Professional | | $237.39 | $289.92 | $323.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $345.00 / $1,155.00 / $3,742.00
| Facility | | $345.00 | $1,155.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.87 / $342.92 / $571.08
| Professional | | $263.87 | $342.92 | $571.08 |