- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $483.63 / $3,839.00 / $8,247.00
| Facility | | $483.63 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.41 / $457.42 / $566.37
| Professional | | $405.41 | $457.42 | $566.37 |
- 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
- $354.20 / $531.82 / $771.86
| Professional | | $354.20 | $531.82 | $771.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.02 / $541.54 / $834.48
| Professional | | $407.02 | $541.54 | $834.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $601.13 / $601.13 / $644.61
| Professional | | $601.13 | $601.13 | $644.61 |
- 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
- $405.41 / $494.27 / $2,054.15
| Professional | | $405.41 | $494.27 | $2,054.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $624.00 / $728.00 / $979.30
| Professional | | $624.00 | $728.00 | $979.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.48 / $556.84 / $899.80
| Professional | | $430.48 | $556.84 | $899.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.62 / $393.62 / $554.29
| Facility | | $393.62 | $393.62 | $554.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.64 / $401.49 / $554.29
| Professional | | $373.64 | $401.49 | $554.29 |
- 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
- $403.31 / $547.33 / $857.09
| Professional | | $403.31 | $547.33 | $857.09 |