- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $536.88 / $4,527.79 / $9,617.00
| Facility | | $536.88 | $4,527.79 | $9,617.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.13 / $388.37 / $759.20
| Professional | | $325.13 | $388.37 | $759.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.35 / $6,182.00 / $17,094.48
| Facility | | $5,058.35 | $6,182.00 | $17,094.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.42 / $443.55 / $696.10
| Professional | | $427.42 | $443.55 | $696.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.52 / $498.90 / $769.39
| Professional | | $380.52 | $498.90 | $769.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.14 / $704.04 / $704.04
| Professional | | $525.14 | $704.04 | $704.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,575.80 / $7,762.55 / $13,862.94
| Facility | | $3,575.80 | $7,762.55 | $13,862.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $5,424.00 / $9,738.29
| Facility | | $627.00 | $5,424.00 | $9,738.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.63 / $490.80 / $1,076.95
| Professional | | $334.63 | $490.80 | $1,076.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $403.80 / $1,126.80
| Professional | | $4.00 | $403.80 | $1,126.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.80 / $501.74 / $796.08
| Professional | | $375.80 | $501.74 | $796.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $364.85 / $370.90 / $424.97
| Facility | | $364.85 | $370.90 | $424.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.85 / $394.07 / $453.59
| Professional | | $364.85 | $394.07 | $453.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,175.00 / $2,824.00 / $5,678.00
| Facility | | $1,175.00 | $2,824.00 | $5,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.69 / $532.05 / $814.32
| Professional | | $353.69 | $532.05 | $814.32 |