- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $441.67 / $2,675.00 / $8,017.00
| Facility | | $441.67 | $2,675.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.11 / $386.68 / $641.38
| Professional | | $277.11 | $386.68 | $641.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,404.00 / $4,354.00 / $8,639.91
| Facility | | $2,404.00 | $4,354.00 | $8,639.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.67 / $423.05 / $423.05
| Professional | | $407.67 | $423.05 | $423.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.71 / $507.71 / $507.71
| Facility | | $507.71 | $507.71 | $507.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.24 / $407.43 / $722.40
| Professional | | $290.24 | $407.43 | $722.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $490.05 / $656.26 / $846.45
| Professional | | $490.05 | $656.26 | $846.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,031.82 / $8,881.18 / $18,372.97
| Facility | | $2,031.82 | $8,881.18 | $18,372.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.00 / $2,824.36 / $8,023.84
| Facility | | $657.00 | $2,824.36 | $8,023.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.81 / $415.71 / $1,249.32
| Professional | | $277.81 | $415.71 | $1,249.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.10 / $342.90 / $889.60
| Professional | | $333.10 | $342.90 | $889.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.71 / $507.71 / $507.71
| Facility | | $507.71 | $507.71 | $507.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.77 / $420.00 / $747.54
| Professional | | $294.77 | $420.00 | $747.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $260.33 / $293.36 / $406.23
| Facility | | $260.33 | $293.36 | $406.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.68 / $333.45 / $437.28
| Professional | | $286.68 | $333.45 | $437.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.00 / $2,391.00 / $4,789.00
| Facility | | $814.00 | $2,391.00 | $4,789.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.98 / $484.51 / $797.17
| Professional | | $337.98 | $484.51 | $797.17 |