- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.38 / $2,543.00 / $8,017.00
| Facility | | $470.38 | $2,543.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.92 / $397.68 / $658.00
| Professional | | $257.92 | $397.68 | $658.00 |
- 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
- $488.29 / $506.72 / $506.72
| Professional | | $488.29 | $506.72 | $506.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.50 / $431.05 / $759.63
| Professional | | $285.50 | $431.05 | $759.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.63 / $761.95 / $787.80
| Professional | | $592.63 | $761.95 | $787.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.00 / $2,679.00 / $8,017.00
| Facility | | $657.00 | $2,679.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.92 / $439.21 / $1,570.74
| Professional | | $257.92 | $439.21 | $1,570.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.00 / $407.00 / $428.90
| Professional | | $407.00 | $407.00 | $428.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $509.16 / $509.16 / $509.16
| Facility | | $509.16 | $509.16 | $509.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.79 / $459.29 / $785.13
| Professional | | $292.79 | $459.29 | $785.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.30 / $292.12 / $492.89
| Facility | | $253.30 | $292.12 | $492.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.82 / $385.67 / $529.54
| Professional | | $282.82 | $385.67 | $529.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.00 / $674.00 / $4,300.00
| Facility | | $144.00 | $674.00 | $4,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.11 / $517.70 / $851.81
| Professional | | $365.11 | $517.70 | $851.81 |