- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.13 / $2,747.00 / $8,017.00
| Facility | | $346.13 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.03 / $354.36 / $546.14
| Professional | | $254.03 | $354.36 | $546.14 |
- 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
- $375.60 / $389.77 / $643.53
| Professional | | $375.60 | $389.77 | $643.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.83 / $463.04 / $783.48
| Professional | | $289.83 | $463.04 | $783.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.38 / $592.52 / $603.29
| Professional | | $447.38 | $592.52 | $603.29 |
- 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
- $256.04 / $370.71 / $1,056.00
| Professional | | $256.04 | $370.71 | $1,056.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $384.10 / $1,006.50
| Professional | | $3.00 | $384.10 | $1,006.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.66 / $460.64 / $794.40
| Professional | | $292.66 | $460.64 | $794.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.02 / $271.70 / $384.30
| Facility | | $270.02 | $271.70 | $384.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.02 / $363.78 / $395.92
| Professional | | $270.02 | $363.78 | $395.92 |
- 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
- $387.20 / $508.13 / $916.45
| Professional | | $387.20 | $508.13 | $916.45 |