- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $2,691.53 / $8,317.64
| Facility | | $676.08 | $2,691.53 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $467.74 / $1,202.26
| Professional | | $389.05 | $467.74 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,691.53 / $57,543.99
| Facility | | $2,630.27 | $2,691.53 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $501.19 / $812.83
| Professional | | $478.63 | $501.19 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $724.44
| Facility | | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $512.86 / $870.96
| Professional | | $371.54 | $512.86 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $851.14 / $1,071.52
| Professional | | $616.60 | $851.14 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $602.56 / $891.25
| Professional | | $407.38 | $602.56 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $489.78 / $489.78
| Professional | | $489.78 | $489.78 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $2,344.23 / $7,762.47
| Facility | | $660.69 | $2,344.23 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $602.56 / $1,412.54
| Professional | | $398.11 | $602.56 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $977.24
| Facility | | $549.54 | $549.54 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $676.08 / $1,000.00
| Professional | | $501.19 | $676.08 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $416.87 / $457.09
| Facility | | $309.03 | $416.87 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $407.38 / $457.09
| Professional | | $309.03 | $407.38 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $1,621.81 / $5,128.61
| Facility | | $223.87 | $1,621.81 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $501.19 / $831.76
| Professional | | $363.08 | $501.19 | $831.76 |