- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $401.95 / $3,839.00 / $8,247.00
| Facility | | $401.95 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.14 / $379.09 / $496.28
| Professional | | $321.14 | $379.09 | $496.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,531.00 / $27,840.00 / $46,480.74
| Facility | | $13,531.00 | $27,840.00 | $46,480.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.50 / $432.21 / $432.21
| Professional | | $416.50 | $432.21 | $432.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.92 / $520.40 / $804.08
| Professional | | $392.92 | $520.40 | $804.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.14 / $685.25 / $685.25
| Professional | | $510.14 | $685.25 | $685.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.00 / $4,761.00 / $8,247.00
| Facility | | $657.00 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.01 / $431.68 / $1,544.00
| Professional | | $336.01 | $431.68 | $1,544.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $459.60 / $1,064.00
| Professional | | $3.00 | $459.60 | $1,064.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.64 / $525.09 / $852.88
| Professional | | $388.64 | $525.09 | $852.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $410.56 / $410.56 / $422.84
| Facility | | $410.56 | $410.56 | $422.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.09 / $416.43 / $435.34
| Professional | | $394.09 | $416.43 | $435.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.00 / $2,391.00 / $6,322.00
| Facility | | $625.00 | $2,391.00 | $6,322.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.77 / $473.56 / $837.21
| Professional | | $360.77 | $473.56 | $837.21 |