- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $394.12 / $2,070.00 / $7,175.47
| Facility | | $394.12 | $2,070.00 | $7,175.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.56 / $335.48 / $645.97
| Professional | | $237.56 | $335.48 | $645.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.69 / $3,159.00 / $14,886.03
| Facility | | $2,344.69 | $3,159.00 | $14,886.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.61 / $380.45 / $396.49
| Professional | | $366.61 | $380.45 | $396.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $441.64 / $441.64 / $441.64
| Facility | | $441.64 | $441.64 | $441.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.52 / $381.07 / $646.69
| Professional | | $260.52 | $381.07 | $646.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.38 / $592.71 / $762.38
| Professional | | $441.38 | $592.71 | $762.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,011.64 / $3,927.36 / $7,262.42
| Facility | | $2,011.64 | $3,927.36 | $7,262.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.89 / $2,266.00 / $8,017.00
| Facility | | $457.89 | $2,266.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.02 / $377.65 / $885.73
| Professional | | $239.02 | $377.65 | $885.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.60 / $352.60 / $790.50
| Professional | | $352.60 | $352.60 | $790.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $441.64 / $441.64 / $441.64
| Facility | | $441.64 | $441.64 | $441.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.24 / $385.98 / $666.10
| Professional | | $264.24 | $385.98 | $666.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.12 / $253.25 / $362.01
| Facility | | $234.12 | $253.25 | $362.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.01 / $306.91 / $389.82
| Professional | | $247.01 | $306.91 | $389.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.00 / $1,305.00 / $3,742.00
| Facility | | $471.00 | $1,305.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.29 / $417.81 / $705.28
| Professional | | $306.29 | $417.81 | $705.28 |