- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.89 / $3,839.00 / $8,247.00
| Facility | | $301.89 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.86 / $301.89 / $719.28
| Professional | | $251.86 | $301.89 | $719.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,531.00 / $27,840.00 / $46,480.74
| Facility | | $13,531.00 | $27,840.00 | $46,480.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.25 / $440.29 / $737.37
| Professional | | $374.25 | $440.29 | $737.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.14 / $385.38 / $576.72
| Professional | | $285.14 | $385.38 | $576.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.67 / $368.64 / $700.23
| Professional | | $288.67 | $368.64 | $700.23 |
- 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
- $251.86 / $302.45 / $1,470.35
| Professional | | $251.86 | $302.45 | $1,470.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.10 / $265.10 / $290.30
| Professional | | $265.10 | $265.10 | $290.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.23 / $385.38 / $684.36
| Professional | | $292.23 | $385.38 | $684.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $414.85 / $414.85 / $478.42
| Facility | | $414.85 | $414.85 | $478.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.11 / $414.85 / $515.37
| Professional | | $213.11 | $414.85 | $515.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.00 / $2,391.00 / $6,322.00
| Facility | | $625.00 | $2,391.00 | $6,322.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.21 / $455.95 / $810.84
| Professional | | $246.21 | $455.95 | $810.84 |