- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $365.51 / $2,725.64 / $6,461.00
| Facility | | $365.51 | $2,725.64 | $6,461.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.54 / $667.41 / $4,894.00
| Professional | | $150.54 | $667.41 | $4,894.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.00 / $3,496.00 / $5,962.00
| Facility | | $1,905.00 | $3,496.00 | $5,962.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.29 / $965.19 / $3,620.09
| Professional | | $338.29 | $965.19 | $3,620.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,064.46 / $2,412.48 / $3,891.26
| Facility | | $2,064.46 | $2,412.48 | $3,891.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.64 / $879.12 / $2,495.42
| Professional | | $334.64 | $879.12 | $2,495.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.43 / $372.54 / $1,320.58
| Facility | | $162.43 | $372.54 | $1,320.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.70 / $1,461.38 / $5,801.00
| Facility | | $178.70 | $1,461.38 | $5,801.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,036.73 / $2,559.66 / $3,929.13
| Professional | | $1,036.73 | $2,559.66 | $3,929.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.00 / $726.17 / $1,876.18
| Professional | | $85.00 | $726.17 | $1,876.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.43 / $372.54 / $1,320.58
| Facility | | $162.43 | $372.54 | $1,320.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.55 / $765.11 / $2,602.23
| Professional | | $404.55 | $765.11 | $2,602.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.40 / $825.40 / $825.40
| Facility | | $825.40 | $825.40 | $825.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.75 / $1,977.88 / $5,603.36
| Professional | | $341.75 | $1,977.88 | $5,603.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $656.49 / $1,581.42 / $3,280.10
| Professional | | $656.49 | $1,581.42 | $3,280.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,960.00 / $4,155.00 / $5,865.00
| Facility | | $2,960.00 | $4,155.00 | $5,865.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $943.29 / $2,537.23 / $3,929.13
| Professional | | $943.29 | $2,537.23 | $3,929.13 |