- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.85 / $2,070.00 / $7,197.00
| Facility | | $380.85 | $2,070.00 | $7,197.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.60 / $343.96 / $494.72
| Professional | | $303.60 | $343.96 | $494.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.35 / $6,182.00 / $17,094.48
| Facility | | $5,058.35 | $6,182.00 | $17,094.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.23 / $385.24 / $635.77
| Professional | | $371.23 | $385.24 | $635.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.91 / $580.91 / $580.91
| Facility | | $580.91 | $580.91 | $580.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.14 / $416.66 / $686.79
| Professional | | $317.14 | $416.66 | $686.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.24 / $600.04 / $767.32
| Professional | | $444.24 | $600.04 | $767.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $617.00 / $2,266.00 / $8,017.00
| Facility | | $617.00 | $2,266.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.39 / $375.10 / $1,544.00
| Professional | | $313.39 | $375.10 | $1,544.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.20 / $399.20 / $756.60
| Professional | | $399.20 | $399.20 | $756.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.91 / $580.91 / $580.91
| Facility | | $580.91 | $580.91 | $580.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.36 / $423.33 / $704.41
| Professional | | $318.36 | $423.33 | $704.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.45 / $345.56 / $362.06
| Facility | | $331.45 | $345.56 | $362.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.42 / $353.82 / $381.66
| Professional | | $331.42 | $353.82 | $381.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.00 / $1,305.00 / $3,742.00
| Facility | | $471.00 | $1,305.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.04 / $427.55 / $672.89
| Professional | | $312.04 | $427.55 | $672.89 |