- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $370.96 / $3,839.00 / $8,247.00
| Facility | | $370.96 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.44 / $370.96 / $1,264.44
| Professional | | $331.44 | $370.96 | $1,264.44 |
- 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
- $446.11 / $524.83 / $878.98
| Professional | | $446.11 | $524.83 | $878.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.01 / $474.39 / $708.61
| Professional | | $351.01 | $474.39 | $708.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.67 / $368.64 / $683.92
| Professional | | $288.67 | $368.64 | $683.92 |
- 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
- $331.44 / $405.22 / $1,639.72
| Professional | | $331.44 | $405.22 | $1,639.72 |
- 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
- $360.06 / $474.39 / $842.43
| Professional | | $360.06 | $474.39 | $842.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.51 / $494.51 / $619.91
| Facility | | $494.51 | $494.51 | $619.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.64 / $502.37 / $773.22
| Professional | | $319.64 | $502.37 | $773.22 |
- 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
- $292.70 / $596.40 / $958.69
| Professional | | $292.70 | $596.40 | $958.69 |