- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.49 / $2,102.00 / $8,113.00
| Facility | | $455.49 | $2,102.00 | $8,113.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.69 / $472.38 / $892.96
| Professional | | $293.69 | $472.38 | $892.96 |
- 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
- $502.83 / $705.39 / $864.02
| Professional | | $502.83 | $705.39 | $864.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $539.62 / $539.62 / $539.62
| Facility | | $539.62 | $539.62 | $539.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.83 / $493.10 / $876.89
| Professional | | $323.83 | $493.10 | $876.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $606.54 / $816.65 / $1,047.68
| Professional | | $606.54 | $816.65 | $1,047.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,636.25 / $3,422.36 / $5,464.22
| Facility | | $1,636.25 | $3,422.36 | $5,464.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.79 / $354.66 / $432.91
| Professional | | $304.79 | $354.66 | $432.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $468.41 / $2,202.00 / $8,017.00
| Facility | | $468.41 | $2,202.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.02 / $516.07 / $1,271.58
| Professional | | $302.02 | $516.07 | $1,271.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.10 / $440.10 / $1,115.80
| Professional | | $440.10 | $440.10 | $1,115.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $539.62 / $539.62 / $539.62
| Facility | | $539.62 | $539.62 | $539.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.83 / $506.87 / $898.84
| Professional | | $323.83 | $506.87 | $898.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $276.60 / $310.20 / $504.97
| Facility | | $276.60 | $310.20 | $504.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.37 / $396.43 / $544.46
| Professional | | $301.37 | $396.43 | $544.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.00 / $2,113.00 / $4,789.00
| Facility | | $637.00 | $2,113.00 | $4,789.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.51 / $550.74 / $937.60
| Professional | | $367.51 | $550.74 | $937.60 |