- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $552.75 / $2,747.00 / $8,017.00
| Facility | | $552.75 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.16 / $499.01 / $686.88
| Professional | | $397.16 | $499.01 | $686.88 |
- 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
- $575.19 / $596.89 / $596.89
| Professional | | $575.19 | $596.89 | $596.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.13 / $564.79 / $931.76
| Professional | | $402.13 | $564.79 | $931.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $696.57 / $895.59 / $925.73
| Professional | | $696.57 | $895.59 | $925.73 |
- 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
- $399.64 / $525.94 / $2,406.04
| Professional | | $399.64 | $525.94 | $2,406.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.50 / $394.50 / $415.50
| Professional | | $394.50 | $394.50 | $415.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $771.02 / $771.02 / $771.02
| Facility | | $771.02 | $771.02 | $771.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.75 / $570.70 / $1,007.10
| Professional | | $416.75 | $570.70 | $1,007.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $348.23 / $448.69 / $575.16
| Facility | | $348.23 | $448.69 | $575.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.79 / $477.78 / $616.99
| Professional | | $428.79 | $477.78 | $616.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.00 / $650.00 / $4,300.00
| Facility | | $144.00 | $650.00 | $4,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.86 / $619.32 / $1,026.11
| Professional | | $478.86 | $619.32 | $1,026.11 |