- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.07 / $2,240.00 / $7,629.00
| Facility | | $417.07 | $2,240.00 | $7,629.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.01 / $388.87 / $582.20
| Professional | | $353.01 | $388.87 | $582.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,736.00 / $4,444.00 / $15,949.31
| Facility | | $3,736.00 | $4,444.00 | $15,949.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.41 / $394.77 / $696.59
| Professional | | $380.41 | $394.77 | $696.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.61 / $392.71 / $631.55
| Professional | | $293.61 | $392.71 | $631.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.69 / $459.69 / $592.78
| Professional | | $459.69 | $459.69 | $592.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,468.31 / $13,468.31 / $13,468.31
| Facility | | $13,468.31 | $13,468.31 | $13,468.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.42 / $323.85 / $774.79
| Professional | | $314.42 | $323.85 | $774.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.00 / $2,371.00 / $8,017.00
| Facility | | $594.00 | $2,371.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.38 / $423.18 / $1,541.00
| Professional | | $353.38 | $423.18 | $1,541.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.40 / $388.40 / $388.40
| Professional | | $388.40 | $388.40 | $388.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.83 / $393.41 / $631.55
| Professional | | $298.83 | $393.41 | $631.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $333.64 / $354.28 / $372.30
| Facility | | $333.64 | $354.28 | $372.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.20 / $367.94 / $395.46
| Professional | | $347.20 | $367.94 | $395.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.00 / $2,884.00 / $6,000.00
| Facility | | $1,122.00 | $2,884.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.26 / $416.24 / $753.95
| Professional | | $321.26 | $416.24 | $753.95 |