- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.71 / $2,450.00 / $8,113.00
| Facility | | $330.71 | $2,450.00 | $8,113.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.41 / $336.17 / $552.22
| Professional | | $276.41 | $336.17 | $552.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,450.00 / $5,951.00 / $8,887.00
| Facility | | $2,450.00 | $5,951.00 | $8,887.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.94 / $396.35 / $396.35
| Professional | | $381.94 | $396.35 | $396.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.47 / $383.41 / $678.19
| Professional | | $278.47 | $383.41 | $678.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.98 / $586.26 / $604.86
| Professional | | $455.98 | $586.26 | $604.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,536.38 / $5,580.06 / $12,848.25
| Facility | | $1,536.38 | $5,580.06 | $12,848.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.62 / $648.62 / $648.62
| Professional | | $648.62 | $648.62 | $648.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $552.62 / $2,679.00 / $8,247.00
| Facility | | $552.62 | $2,679.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.98 / $361.05 / $1,056.00
| Professional | | $285.98 | $361.05 | $1,056.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.64 / $393.80 / $561.26
| Professional | | $300.64 | $393.80 | $561.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.32 / $540.32 / $540.32
| Facility | | $540.32 | $540.32 | $540.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.26 / $392.03 / $733.66
| Professional | | $294.26 | $392.03 | $733.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.87 / $307.82 / $372.63
| Facility | | $294.87 | $307.82 | $372.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.27 / $363.79 / $396.12
| Professional | | $299.27 | $363.79 | $396.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.00 / $2,715.00 / $4,815.00
| Facility | | $1,122.00 | $2,715.00 | $4,815.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.86 / $407.60 / $726.96
| Professional | | $325.86 | $407.60 | $726.96 |