- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.59 / $3,839.00 / $8,247.00
| Facility | | $456.59 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.87 / $470.39 / $587.78
| Professional | | $394.87 | $470.39 | $587.78 |
- 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
- $479.18 / $497.27 / $497.27
| Professional | | $479.18 | $497.27 | $497.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.66 / $647.63 / $980.31
| Professional | | $474.66 | $647.63 | $980.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.50 / $787.55 / $787.55
| Professional | | $584.50 | $787.55 | $787.55 |
- 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
- $413.90 / $524.04 / $1,649.59
| Professional | | $413.90 | $524.04 | $1,649.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $610.20 / $1,182.00
| Professional | | $10.00 | $610.20 | $1,182.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.66 / $647.63 / $1,118.73
| Professional | | $474.66 | $647.63 | $1,118.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.37 / $471.37 / $623.00
| Facility | | $471.37 | $471.37 | $623.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.11 / $482.59 / $623.00
| Professional | | $448.11 | $482.59 | $623.00 |
- 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
- $459.59 / $603.05 / $983.53
| Professional | | $459.59 | $603.05 | $983.53 |