- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $397.46 / $3,839.00 / $8,247.00
| Facility | | $397.46 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.35 / $406.53 / $533.90
| Professional | | $358.35 | $406.53 | $533.90 |
- 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
- $291.51 / $452.54 / $833.31
| Professional | | $291.51 | $452.54 | $833.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.95 / $561.84 / $888.42
| Professional | | $342.95 | $561.84 | $888.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.70 / $494.70 / $529.86
| Professional | | $494.70 | $494.70 | $529.86 |
- 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
- $357.64 / $465.91 / $1,768.05
| Professional | | $357.64 | $465.91 | $1,768.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $805.50 / $1,052.50
| Professional | | $15.00 | $805.50 | $1,052.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.04 / $561.84 / $976.05
| Professional | | $368.04 | $561.84 | $976.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.87 / $323.87 / $547.73
| Facility | | $323.87 | $323.87 | $547.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.50 / $330.35 / $547.73
| Professional | | $307.50 | $330.35 | $547.73 |
- 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
- $342.17 / $528.70 / $739.57
| Professional | | $342.17 | $528.70 | $739.57 |