- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $807.49 / $2,747.00 / $8,017.00
| Facility | | $807.49 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.68 / $625.73 / $873.32
| Professional | | $392.68 | $625.73 | $873.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,736.00 / $4,444.00 / $15,949.31
| Facility | | $3,736.00 | $4,444.00 | $15,949.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.76 / $713.71 / $713.71
| Professional | | $687.76 | $713.71 | $713.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.83 / $724.83 / $724.83
| Facility | | $724.83 | $724.83 | $724.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.90 / $666.19 / $1,173.16
| Professional | | $349.90 | $666.19 | $1,173.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $840.39 / $1,120.61 / $1,451.58
| Professional | | $840.39 | $1,120.61 | $1,451.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,470.13 / $2,470.13 / $2,470.13
| Facility | | $2,470.13 | $2,470.13 | $2,470.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $934.00 / $3,077.00 / $8,017.00
| Facility | | $934.00 | $3,077.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $419.71 / $678.16 / $2,296.58
| Professional | | $419.71 | $678.16 | $2,296.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $386.60 / $416.10 / $1,646.10
| Professional | | $386.60 | $416.10 | $1,646.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.83 / $724.83 / $724.83
| Facility | | $724.83 | $724.83 | $724.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.40 / $677.66 / $1,203.36
| Professional | | $367.40 | $677.66 | $1,203.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.60 / $446.91 / $715.65
| Facility | | $362.60 | $446.91 | $715.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.18 / $556.44 / $780.66
| Professional | | $440.18 | $556.44 | $780.66 |
- 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
- $538.85 / $788.92 / $1,373.07
| Professional | | $538.85 | $788.92 | $1,373.07 |