- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.52 / $2,747.00 / $8,017.00
| Facility | | $515.52 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.63 / $464.20 / $692.49
| Professional | | $301.63 | $464.20 | $692.49 |
- 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
- $536.11 / $556.34 / $556.34
| Professional | | $536.11 | $556.34 | $556.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.98 / $505.76 / $838.49
| Professional | | $334.98 | $505.76 | $838.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $656.63 / $844.24 / $876.11
| Professional | | $656.63 | $844.24 | $876.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.00 / $3,077.00 / $8,017.00
| Facility | | $832.00 | $3,077.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.80 / $484.17 / $1,659.00
| Professional | | $307.80 | $484.17 | $1,659.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $473.30 / $473.30 / $500.00
| Professional | | $473.30 | $473.30 | $500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $596.40 / $596.40 / $596.40
| Facility | | $596.40 | $596.40 | $596.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.46 / $521.09 / $859.39
| Professional | | $346.46 | $521.09 | $859.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.64 / $343.65 / $530.82
| Facility | | $316.64 | $343.65 | $530.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.23 / $481.49 / $570.29
| Professional | | $331.23 | $481.49 | $570.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.00 / $2,391.00 / $6,000.00
| Facility | | $637.00 | $2,391.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.27 / $560.74 / $1,041.80
| Professional | | $407.27 | $560.74 | $1,041.80 |