- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.78 / $2,747.00 / $7,629.00
| Facility | | $460.78 | $2,747.00 | $7,629.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.39 / $406.08 / $1,054.33
| Professional | | $285.39 | $406.08 | $1,054.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,292.00 / $5,951.00 / $9,100.00
| Facility | | $3,292.00 | $5,951.00 | $9,100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.27 / $441.32 / $759.72
| Professional | | $425.27 | $441.32 | $759.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $522.41 / $522.41 / $522.41
| Facility | | $522.41 | $522.41 | $522.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.24 / $434.70 / $758.33
| Professional | | $305.24 | $434.70 | $758.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.59 / $688.73 / $881.92
| Professional | | $510.59 | $688.73 | $881.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,380.17 / $3,302.53 / $6,493.86
| Facility | | $2,380.17 | $3,302.53 | $6,493.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $3,190.48 / $8,247.00
| Facility | | $540.00 | $3,190.48 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.26 / $448.92 / $1,099.43
| Professional | | $298.26 | $448.92 | $1,099.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.60 / $367.60 / $919.90
| Professional | | $367.60 | $367.60 | $919.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $522.41 / $522.41 / $522.41
| Facility | | $522.41 | $522.41 | $522.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.12 / $447.81 / $777.64
| Professional | | $309.12 | $447.81 | $777.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.41 / $309.35 / $422.45
| Facility | | $300.41 | $309.35 | $422.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.41 / $385.41 / $453.63
| Professional | | $300.41 | $385.41 | $453.63 |
- 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
- $371.69 / $497.49 / $795.11
| Professional | | $371.69 | $497.49 | $795.11 |