- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.36 / $2,240.00 / $7,629.00
| Facility | | $354.36 | $2,240.00 | $7,629.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.14 / $326.18 / $442.86
| Professional | | $298.14 | $326.18 | $442.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.73 / $334.73 / $334.73
| Professional | | $334.73 | $334.73 | $334.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,083.51 / $1,395.00 / $12,759.45
| Facility | | $1,083.51 | $1,395.00 | $12,759.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.01 / $335.20 / $583.25
| Professional | | $323.01 | $335.20 | $583.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.92 / $332.69 / $580.55
| Professional | | $255.92 | $332.69 | $580.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.94 / $393.94 / $507.99
| Professional | | $393.94 | $393.94 | $507.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.54 / $294.54 / $399.44
| Professional | | $294.54 | $294.54 | $399.44 |
- 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
- $306.69 / $361.65 / $1,705.05
| Professional | | $306.69 | $361.65 | $1,705.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.80 / $423.80 / $423.80
| Professional | | $423.80 | $423.80 | $423.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.92 / $334.73 / $564.96
| Professional | | $255.92 | $334.73 | $564.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.32 / $314.95 / $400.40
| Facility | | $308.32 | $314.95 | $400.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.58 / $314.95 / $400.40
| Professional | | $305.58 | $314.95 | $400.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.00 / $577.00 / $3,742.00
| Facility | | $144.00 | $577.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.37 / $368.66 / $625.37
| Professional | | $280.37 | $368.66 | $625.37 |