- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.31 / $2,180.00 / $7,629.00
| Facility | | $375.31 | $2,180.00 | $7,629.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.37 / $347.75 / $501.36
| Professional | | $249.37 | $347.75 | $501.36 |
- 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
- $399.58 / $414.66 / $414.66
| Professional | | $399.58 | $414.66 | $414.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.37 / $393.90 / $670.33
| Professional | | $263.37 | $393.90 | $670.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.54 / $617.84 / $638.44
| Professional | | $480.54 | $617.84 | $638.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,664.19 / $6,045.38 / $9,728.64
| Facility | | $5,664.19 | $6,045.38 | $9,728.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.89 / $403.53 / $681.36
| Professional | | $388.89 | $403.53 | $681.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.12 / $2,467.00 / $8,017.00
| Facility | | $498.12 | $2,467.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.02 / $375.32 / $934.00
| Professional | | $253.02 | $375.32 | $934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.20 / $387.40 / $589.65
| Professional | | $273.20 | $387.40 | $589.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $492.13 / $492.13 / $492.13
| Facility | | $492.13 | $492.13 | $492.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.11 / $398.97 / $719.24
| Professional | | $271.11 | $398.97 | $719.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.88 / $283.58 / $395.19
| Facility | | $275.88 | $283.58 | $395.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.88 / $346.70 / $421.61
| Professional | | $275.88 | $346.70 | $421.61 |
- 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
- $344.58 / $438.04 / $779.67
| Professional | | $344.58 | $438.04 | $779.67 |