- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.98 / $4,845.00 / $9,770.54
| Facility | | $497.98 | $4,845.00 | $9,770.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.50 / $310.25 / $1,246.00
| Professional | | $253.50 | $310.25 | $1,246.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,800.00 / $7,463.00 / $11,048.00
| Facility | | $2,800.00 | $7,463.00 | $11,048.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.33 / $296.10 / $464.67
| Professional | | $285.33 | $296.10 | $464.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.64 / $373.34 / $586.40
| Professional | | $282.64 | $373.34 | $586.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.75 / $437.44 / $438.16
| Professional | | $330.75 | $437.44 | $438.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,444.92 / $7,316.51 / $14,152.80
| Facility | | $2,444.92 | $7,316.51 | $14,152.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.98 / $4,378.68 / $9,770.54
| Facility | | $497.98 | $4,378.68 | $9,770.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.02 / $406.46 / $1,198.00
| Professional | | $271.02 | $406.46 | $1,198.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $565.50 / $725.90
| Professional | | $5.00 | $565.50 | $725.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.18 / $380.67 / $646.57
| Professional | | $298.18 | $380.67 | $646.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $277.97 / $277.97 / $552.57
| Facility | | $277.97 | $277.97 | $552.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.13 / $279.77 / $552.57
| Professional | | $269.13 | $279.77 | $552.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,334.00 / $2,824.00 / $5,678.00
| Facility | | $1,334.00 | $2,824.00 | $5,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.05 / $346.78 / $591.91
| Professional | | $270.05 | $346.78 | $591.91 |