- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.25 / $3,623.00 / $7,799.00
| Facility | | $624.25 | $3,623.00 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.73 / $551.58 / $739.45
| Professional | | $432.73 | $551.58 | $739.45 |
- 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
- $555.04 / $575.99 / $1,009.37
| Professional | | $555.04 | $575.99 | $1,009.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.00 / $549.00 / $549.00
| Facility | | $549.00 | $549.00 | $549.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.08 / $545.87 / $871.12
| Professional | | $384.08 | $545.87 | $871.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.92 / $676.92 / $872.91
| Professional | | $676.92 | $676.92 | $872.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.00 / $3,839.00 / $8,017.00
| Facility | | $832.00 | $3,839.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.14 / $551.64 / $2,493.78
| Professional | | $446.14 | $551.64 | $2,493.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $715.90 / $715.90 / $715.90
| Professional | | $715.90 | $715.90 | $715.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.00 / $549.00 / $549.00
| Facility | | $549.00 | $549.00 | $549.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.57 / $552.94 / $871.12
| Professional | | $406.57 | $552.94 | $871.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.58 / $451.13 / $733.03
| Facility | | $382.58 | $451.13 | $733.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.20 / $540.40 / $733.03
| Professional | | $442.20 | $540.40 | $733.03 |
- 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
- $477.70 / $642.29 / $992.95
| Professional | | $477.70 | $642.29 | $992.95 |