- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $359.84 / $3,623.00 / $7,799.00
| Facility | | $359.84 | $3,623.00 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.84 / $410.11 / $528.96
| Professional | | $359.84 | $410.11 | $528.96 |
- 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
- $362.29 / $575.54 / $755.31
| Professional | | $362.29 | $575.54 | $755.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.27 / $528.59 / $821.21
| Professional | | $396.27 | $528.59 | $821.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $481.73 / $637.61 / $642.63
| Professional | | $481.73 | $637.61 | $642.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,991.65 / $14,991.65 / $14,991.65
| Facility | | $14,991.65 | $14,991.65 | $14,991.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $768.00 / $3,839.00 / $8,017.00
| Facility | | $768.00 | $3,839.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.42 / $446.62 / $1,749.00
| Professional | | $374.42 | $446.62 | $1,749.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $512.10 / $1,028.09
| Professional | | $3.00 | $512.10 | $1,028.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.84 / $535.55 / $859.92
| Professional | | $399.84 | $535.55 | $859.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.20 / $398.20 / $433.38
| Facility | | $398.20 | $398.20 | $433.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.16 / $399.06 / $433.38
| Professional | | $387.16 | $399.06 | $433.38 |
- 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
- $399.00 / $480.46 / $815.61
| Professional | | $399.00 | $480.46 | $815.61 |