- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.85 / $5,091.00 / $9,250.00
| Facility | | $900.85 | $5,091.00 | $9,250.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.50 / $462.96 / $982.06
| Professional | | $294.50 | $462.96 | $982.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,153.00 / $7,363.00 / $9,410.00
| Facility | | $6,153.00 | $7,363.00 | $9,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.83 / $420.51 / $576.72
| Professional | | $328.83 | $420.51 | $576.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.02 / $589.25 / $5,895.00
| Professional | | $393.02 | $589.25 | $5,895.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.14 / $638.84 / $918.00
| Professional | | $357.14 | $638.84 | $918.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.19 / $403.43 / $497.56
| Professional | | $336.19 | $403.43 | $497.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $336.19 / $493.68 / $981.31
| Facility | | $336.19 | $493.68 | $981.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.00 / $676.00 / $1,071.00
| Professional | | $513.00 | $676.00 | $1,071.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.41 / $659.83 / $5,122.00
| Facility | | $408.41 | $659.83 | $5,122.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.41 / $659.83 / $5,122.00
| Professional | | $408.41 | $659.83 | $5,122.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,373.00 / $17,192.00
| Facility | | $6,303.00 | $9,373.00 | $17,192.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.20 / $584.38 / $819.10
| Professional | | $317.20 | $584.38 | $819.10 |