- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.63 / $2,070.00 / $7,197.00
| Facility | | $587.63 | $2,070.00 | $7,197.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.38 / $528.99 / $747.90
| Professional | | $475.38 | $528.99 | $747.90 |
- 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
- $569.59 / $690.18 / $994.70
| Professional | | $569.59 | $690.18 | $994.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $876.58 / $876.58 / $876.58
| Facility | | $876.58 | $876.58 | $876.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $490.59 / $638.80 / $1,040.15
| Professional | | $490.59 | $638.80 | $1,040.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.07 / $920.19 / $1,176.39
| Professional | | $681.07 | $920.19 | $1,176.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,756.93 / $2,092.96 / $6,654.75
| Facility | | $1,756.93 | $2,092.96 | $6,654.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $641.00 / $2,266.00 / $8,017.00
| Facility | | $641.00 | $2,266.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.65 / $566.11 / $1,978.00
| Professional | | $476.65 | $566.11 | $1,978.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $604.70 / $604.70 / $1,166.20
| Professional | | $604.70 | $604.70 | $1,166.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $876.58 / $876.58 / $876.58
| Facility | | $876.58 | $876.58 | $876.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.18 / $646.69 / $1,061.08
| Professional | | $492.18 | $646.69 | $1,061.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.91 / $502.61 / $550.66
| Facility | | $470.91 | $502.61 | $550.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.05 / $535.97 / $588.87
| Professional | | $489.05 | $535.97 | $588.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.00 / $650.00 / $3,742.00
| Facility | | $162.00 | $650.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.87 / $646.19 / $1,104.81
| Professional | | $482.87 | $646.19 | $1,104.81 |