- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.24 / $2,809.00 / $8,709.37
| Facility | | $307.24 | $2,809.00 | $8,709.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.35 / $294.80 / $540.07
| Professional | | $235.35 | $294.80 | $540.07 |
- 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
- $326.45 / $524.28 / $524.28
| Professional | | $326.45 | $524.28 | $524.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.69 / $328.07 / $565.25
| Professional | | $237.69 | $328.07 | $565.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.66 / $502.28 / $518.69
| Professional | | $390.66 | $502.28 | $518.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.70 / $5,886.94 / $9,683.06
| Facility | | $1,760.70 | $5,886.94 | $9,683.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.00 / $315.00 / $328.84
| Professional | | $315.00 | $315.00 | $328.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $387.81 / $2,751.21 / $8,247.00
| Facility | | $387.81 | $2,751.21 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.62 / $329.13 / $804.15
| Professional | | $240.62 | $329.13 | $804.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.05 / $337.64 / $478.99
| Professional | | $255.05 | $337.64 | $478.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.76 / $457.76 / $457.76
| Facility | | $457.76 | $457.76 | $457.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.31 / $333.92 / $592.17
| Professional | | $249.31 | $333.92 | $592.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.93 / $262.89 / $329.98
| Facility | | $251.93 | $262.89 | $329.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.03 / $313.57 / $342.21
| Professional | | $255.03 | $313.57 | $342.21 |
- 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
- $277.64 / $347.54 / $604.33
| Professional | | $277.64 | $347.54 | $604.33 |