- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $381.67 / $2,070.00 / $7,629.00
| Facility | | $381.67 | $2,070.00 | $7,629.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.02 / $342.05 / $449.45
| Professional | | $264.02 | $342.05 | $449.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,299.82 / $2,746.00 / $13,822.74
| Facility | | $2,299.82 | $2,746.00 | $13,822.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.14 / $636.89 / $739.50
| Professional | | $393.14 | $636.89 | $739.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.04 / $463.44 / $725.89
| Professional | | $333.04 | $463.44 | $725.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.13 / $647.10 / $647.10
| Professional | | $482.13 | $647.10 | $647.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,307.76 / $3,307.76 / $3,307.76
| Facility | | $3,307.76 | $3,307.76 | $3,307.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $617.00 / $2,326.00 / $8,017.00
| Facility | | $617.00 | $2,326.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.35 / $381.67 / $1,234.00
| Professional | | $266.35 | $381.67 | $1,234.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $489.10 / $1,016.10
| Professional | | $6.00 | $489.10 | $1,016.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.67 / $465.54 / $730.40
| Professional | | $332.67 | $465.54 | $730.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.66 / $315.56 / $415.03
| Facility | | $301.66 | $315.56 | $415.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.66 / $374.23 / $413.48
| Professional | | $301.66 | $374.23 | $413.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.00 / $577.00 / $3,742.00
| Facility | | $162.00 | $577.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.45 / $493.36 / $801.69
| Professional | | $365.45 | $493.36 | $801.69 |