- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $484.72 / $2,675.00 / $8,017.00
| Facility | | $484.72 | $2,675.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.12 / $398.37 / $772.20
| Professional | | $261.12 | $398.37 | $772.20 |
- 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
- $413.74 / $429.35 / $624.75
| Professional | | $413.74 | $429.35 | $624.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.55 / $452.77 / $775.20
| Professional | | $300.55 | $452.77 | $775.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.80 / $254.38 / $649.76
| Professional | | $46.80 | $254.38 | $649.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,348.25 / $6,932.26 / $25,954.04
| Facility | | $5,348.25 | $6,932.26 | $25,954.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $721.88 / $2,679.00 / $8,017.00
| Facility | | $721.88 | $2,679.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.16 / $430.14 / $959.74
| Professional | | $282.16 | $430.14 | $959.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $157.30 / $1,153.80
| Professional | | $3.00 | $157.30 | $1,153.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.02 / $463.97 / $775.20
| Professional | | $305.02 | $463.97 | $775.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $276.70 / $359.55 / $464.70
| Facility | | $276.70 | $359.55 | $464.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.70 / $416.74 / $452.85
| Professional | | $276.70 | $416.74 | $452.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.00 / $2,391.00 / $4,789.00
| Facility | | $814.00 | $2,391.00 | $4,789.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $386.20 / $497.94 / $819.26
| Professional | | $386.20 | $497.94 | $819.26 |