- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $503.18 / $2,202.00 / $7,351.31
| Facility | | $503.18 | $2,202.00 | $7,351.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.97 / $421.06 / $766.59
| Professional | | $310.97 | $421.06 | $766.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $618.97 / $618.97 / $618.97
| Professional | | $618.97 | $618.97 | $618.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,736.00 / $4,444.00 / $15,949.31
| Facility | | $3,736.00 | $4,444.00 | $15,949.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.28 / $702.08 / $868.74
| Professional | | $463.28 | $702.08 | $868.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.82 / $524.47 / $881.93
| Professional | | $350.82 | $524.47 | $881.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.51 / $753.83 / $753.83
| Professional | | $565.51 | $753.83 | $753.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,052.34 / $3,422.36 / $8,186.60
| Facility | | $2,052.34 | $3,422.36 | $8,186.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $561.97 / $2,467.00 / $7,821.05
| Facility | | $561.97 | $2,467.00 | $7,821.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.12 / $471.66 / $1,043.83
| Professional | | $321.12 | $471.66 | $1,043.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $496.40 / $1,261.20
| Professional | | $4.00 | $496.40 | $1,261.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.92 / $534.64 / $881.93
| Professional | | $354.92 | $534.64 | $881.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $321.63 / $326.22 / $458.69
| Facility | | $321.63 | $326.22 | $458.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.63 / $411.34 / $492.32
| Professional | | $321.63 | $411.34 | $492.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.00 / $2,391.00 / $4,789.00
| Facility | | $912.00 | $2,391.00 | $4,789.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.47 / $570.73 / $902.30
| Professional | | $432.47 | $570.73 | $902.30 |