- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.00 / $2,422.00 / $7,799.00
| Facility | | $594.00 | $2,422.00 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.95 / $472.18 / $621.04
| Professional | | $425.95 | $472.18 | $621.04 |
- 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
- $457.61 / $671.03 / $946.48
| Professional | | $457.61 | $671.03 | $946.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.28 / $653.29 / $1,046.23
| Professional | | $497.28 | $653.29 | $1,046.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $633.34 / $853.10 / $853.10
| Professional | | $633.34 | $853.10 | $853.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,594.08 / $8,594.08 / $8,594.08
| Facility | | $8,594.08 | $8,594.08 | $8,594.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $641.00 / $2,371.00 / $8,017.00
| Facility | | $641.00 | $2,371.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.95 / $533.72 / $1,978.00
| Professional | | $425.95 | $533.72 | $1,978.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $923.00 / $1,279.50
| Professional | | $6.00 | $923.00 | $1,279.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.28 / $659.39 / $1,125.74
| Professional | | $497.28 | $659.39 | $1,125.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.19 / $509.27 / $509.27
| Facility | | $478.19 | $509.27 | $509.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.19 / $509.27 / $535.50
| Professional | | $478.19 | $509.27 | $535.50 |
- 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
- $453.39 / $616.98 / $1,059.24
| Professional | | $453.39 | $616.98 | $1,059.24 |