- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $560.61 / $5,526.00 / $13,947.00
| Facility | | $560.61 | $5,526.00 | $13,947.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.71 / $532.94 / $649.65
| Professional | | $475.71 | $532.94 | $649.65 |
- 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
- $407.45 / $743.94 / $941.50
| Professional | | $407.45 | $743.94 | $941.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.52 / $654.36 / $962.84
| Professional | | $456.52 | $654.36 | $962.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $699.74 / $699.74 / $737.86
| Professional | | $699.74 | $699.74 | $737.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.00 / $5,526.00 / $13,969.00
| Facility | | $832.00 | $5,526.00 | $13,969.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $481.72 / $560.61 / $2,371.42
| Professional | | $481.72 | $560.61 | $2,371.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $10.00 / $1,149.09
| Professional | | $10.00 | $10.00 | $1,149.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.14 / $663.52 / $1,062.59
| Professional | | $501.14 | $663.52 | $1,062.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.17 / $454.17 / $556.16
| Facility | | $454.17 | $454.17 | $556.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.62 / $463.22 / $556.16
| Professional | | $433.62 | $463.22 | $556.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.00 / $2,391.00 / $6,322.00
| Facility | | $656.00 | $2,391.00 | $6,322.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.82 / $632.26 / $1,026.25
| Professional | | $477.82 | $632.26 | $1,026.25 |