- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $396.16 / $1,825.00 / $7,197.00
| Facility | | $396.16 | $1,825.00 | $7,197.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.39 / $354.86 / $623.61
| Professional | | $305.39 | $354.86 | $623.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,083.51 / $1,395.00 / $12,759.45
| Facility | | $1,083.51 | $1,395.00 | $12,759.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.72 / $398.20 / $398.20
| Professional | | $383.72 | $398.20 | $398.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $581.51 / $581.51 / $581.51
| Facility | | $581.51 | $581.51 | $581.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.93 / $430.47 / $713.50
| Professional | | $326.93 | $430.47 | $713.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.68 / $618.14 / $792.26
| Professional | | $458.68 | $618.14 | $792.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,352.51 / $3,380.47 / $5,945.75
| Facility | | $2,352.51 | $3,380.47 | $5,945.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.48 / $348.80 / $403.74
| Professional | | $342.48 | $348.80 | $403.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $574.00 / $2,463.00 / $8,017.00
| Facility | | $574.00 | $2,463.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.95 / $381.93 / $1,426.00
| Professional | | $314.95 | $381.93 | $1,426.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.60 / $479.20 / $774.10
| Professional | | $452.60 | $479.20 | $774.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $581.51 / $581.51 / $581.51
| Facility | | $581.51 | $581.51 | $581.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.76 / $434.40 / $726.85
| Professional | | $331.76 | $434.40 | $726.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $333.80 / $334.96 / $405.85
| Facility | | $333.80 | $334.96 | $405.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.80 / $363.56 / $398.63
| Professional | | $333.80 | $363.56 | $398.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.00 / $650.00 / $3,742.00
| Facility | | $226.00 | $650.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.02 / $448.98 / $695.09
| Professional | | $328.02 | $448.98 | $695.09 |