- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $403.78 / $2,070.00 / $7,629.00
| Facility | | $403.78 | $2,070.00 | $7,629.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.32 / $427.43 / $586.69
| Professional | | $390.32 | $427.43 | $586.69 |
- 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
- $458.82 / $476.14 / $476.14
| Professional | | $458.82 | $476.14 | $476.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.58 / $562.71 / $866.26
| Professional | | $417.58 | $562.71 | $866.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.04 / $714.76 / $722.87
| Professional | | $540.04 | $714.76 | $722.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.00 / $2,326.00 / $8,017.00
| Facility | | $594.00 | $2,326.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.32 / $457.06 / $1,234.00
| Professional | | $390.32 | $457.06 | $1,234.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $721.10 / $1,157.90
| Professional | | $3.00 | $721.10 | $1,157.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.61 / $572.75 / $908.99
| Professional | | $441.61 | $572.75 | $908.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $414.35 / $444.07 / $680.07
| Facility | | $414.35 | $444.07 | $680.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.35 / $444.07 / $531.41
| Professional | | $414.35 | $444.07 | $531.41 |
- 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
- $416.20 / $568.85 / $959.97
| Professional | | $416.20 | $568.85 | $959.97 |