- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.41 / $2,747.00 / $8,017.00
| Facility | | $570.41 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.33 / $495.00 / $725.05
| Professional | | $362.33 | $495.00 | $725.05 |
- 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
- $591.19 / $613.50 / $613.50
| Professional | | $591.19 | $613.50 | $613.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.91 / $577.04 / $965.72
| Professional | | $394.91 | $577.04 | $965.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $715.87 / $920.40 / $951.94
| Professional | | $715.87 | $920.40 | $951.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $918.00 / $3,120.00 / $8,017.00
| Facility | | $918.00 | $3,120.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.33 / $569.26 / $2,236.67
| Professional | | $362.33 | $569.26 | $2,236.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $573.00 / $573.00 / $604.60
| Professional | | $573.00 | $573.00 | $604.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.21 / $709.21 / $709.21
| Facility | | $709.21 | $709.21 | $709.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.87 / $585.48 / $1,031.49
| Professional | | $410.87 | $585.48 | $1,031.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $361.32 / $407.84 / $592.79
| Facility | | $361.32 | $407.84 | $592.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.45 / $525.66 / $635.17
| Professional | | $395.45 | $525.66 | $635.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.00 / $557.00 / $3,742.00
| Facility | | $144.00 | $557.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.80 / $626.88 / $1,127.17
| Professional | | $480.80 | $626.88 | $1,127.17 |