- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.22 / $2,747.00 / $8,017.00
| Facility | | $563.22 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.90 / $467.21 / $642.70
| Professional | | $339.90 | $467.21 | $642.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $4,354.00 / $8,459.92
| Facility | | $1,350.00 | $4,354.00 | $8,459.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.55 / $535.02 / $903.88
| Professional | | $515.55 | $535.02 | $903.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.35 / $510.70 / $832.09
| Professional | | $357.35 | $510.70 | $832.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $623.13 / $801.17 / $826.33
| Professional | | $623.13 | $801.17 | $826.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.55 / $546.55 / $546.55
| Professional | | $546.55 | $546.55 | $546.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.00 / $3,077.00 / $8,017.00
| Facility | | $832.00 | $3,077.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.60 / $530.24 / $2,234.77
| Professional | | $361.60 | $530.24 | $2,234.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.60 / $450.60 / $476.60
| Professional | | $450.60 | $450.60 | $476.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $622.27 / $622.27 / $622.27
| Facility | | $622.27 | $622.27 | $622.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.87 / $522.62 / $857.65
| Professional | | $365.87 | $522.62 | $857.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $360.56 / $365.73 / $512.01
| Facility | | $360.56 | $365.73 | $512.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.34 / $429.95 / $550.48
| Professional | | $359.34 | $429.95 | $550.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.00 / $2,391.00 / $6,000.00
| Facility | | $637.00 | $2,391.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.31 / $557.41 / $951.46
| Professional | | $426.31 | $557.41 | $951.46 |