- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.00 / $2,747.00 / $8,017.00
| Facility | | $882.00 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.92 / $375.32 / $545.32
| Professional | | $332.92 | $375.32 | $545.32 |
- 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
- $375.17 / $389.32 / $639.71
| Professional | | $375.17 | $389.32 | $639.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.66 / $426.66 / $426.66
| Facility | | $426.66 | $426.66 | $426.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.53 / $462.34 / $753.11
| Professional | | $360.53 | $462.34 | $753.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.33 / $604.72 / $772.65
| Professional | | $447.33 | $604.72 | $772.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $934.00 / $2,679.00 / $8,017.00
| Facility | | $934.00 | $2,679.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.92 / $394.59 / $1,857.36
| Professional | | $332.92 | $394.59 | $1,857.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $518.79 / $518.79 / $767.00
| Professional | | $518.79 | $518.79 | $767.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.66 / $426.66 / $426.66
| Facility | | $426.66 | $426.66 | $426.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.53 / $466.88 / $787.71
| Professional | | $360.53 | $466.88 | $787.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.00 / $363.00 / $521.79
| Facility | | $363.00 | $363.00 | $521.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.37 / $363.19 / $521.79
| Professional | | $353.37 | $363.19 | $521.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,334.00 / $2,824.00 / $5,678.00
| Facility | | $1,334.00 | $2,824.00 | $5,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.12 / $453.46 / $703.57
| Professional | | $331.12 | $453.46 | $703.57 |