- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.00 / $2,868.00 / $8,247.00
| Facility | | $832.00 | $2,868.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.04 / $456.87 / $567.12
| Professional | | $371.04 | $456.87 | $567.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.35 / $6,182.00 / $17,094.48
| Facility | | $5,058.35 | $6,182.00 | $17,094.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.52 / $429.12 / $429.12
| Professional | | $413.52 | $429.12 | $429.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.38 / $507.90 / $810.08
| Professional | | $398.38 | $507.90 | $810.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $652.94 / $652.94 / $672.50
| Professional | | $652.94 | $652.94 | $672.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $934.00 / $3,654.00 / $8,451.00
| Facility | | $934.00 | $3,654.00 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.04 / $503.98 / $2,467.00
| Professional | | $371.04 | $503.98 | $2,467.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $497.90 / $1,055.30
| Professional | | $15.00 | $497.90 | $1,055.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.21 / $511.50 / $804.26
| Professional | | $399.21 | $511.50 | $804.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $335.59 / $401.03 / $401.03
| Facility | | $335.59 | $401.03 | $401.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.59 / $401.03 / $425.47
| Professional | | $335.59 | $401.03 | $425.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,440.00 / $3,475.00 / $6,000.00
| Facility | | $1,440.00 | $3,475.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.44 / $472.96 / $806.70
| Professional | | $360.44 | $472.96 | $806.70 |