- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.34 / $2,747.00 / $8,113.00
| Facility | | $331.34 | $2,747.00 | $8,113.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.43 / $416.80 / $639.90
| Professional | | $314.43 | $416.80 | $639.90 |
- 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
- $476.72 / $494.71 / $494.71
| Professional | | $476.72 | $494.71 | $494.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.79 / $494.71 / $912.93
| Professional | | $336.79 | $494.71 | $912.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $572.91 / $736.61 / $758.65
| Professional | | $572.91 | $736.61 | $758.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.00 / $4,761.00 / $8,247.00
| Facility | | $657.00 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.00 / $440.82 / $2,106.14
| Professional | | $318.00 | $440.82 | $2,106.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.30 / $353.30 / $371.50
| Professional | | $353.30 | $353.30 | $371.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.74 / $620.74 / $620.74
| Facility | | $620.74 | $620.74 | $620.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.18 / $517.20 / $985.32
| Professional | | $360.18 | $517.20 | $985.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $356.83 / $375.56 / $518.66
| Facility | | $356.83 | $375.56 | $518.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.83 / $461.31 / $503.19
| Professional | | $354.83 | $461.31 | $503.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.00 / $1,219.00 / $4,300.00
| Facility | | $412.00 | $1,219.00 | $4,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.80 / $572.69 / $1,027.82
| Professional | | $444.80 | $572.69 | $1,027.82 |