- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $546.74 / $2,562.00 / $7,495.00
| Facility | | $546.74 | $2,562.00 | $7,495.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.77 / $421.32 / $649.59
| Professional | | $284.77 | $421.32 | $649.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,314.73 / $2,182.17 / $4,503.00
| Facility | | $1,314.73 | $2,182.17 | $4,503.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.79 / $422.64 / $616.40
| Professional | | $282.79 | $422.64 | $616.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $290.94 / $291.52
| Facility | | $80.00 | $290.94 | $291.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.53 / $530.53 / $530.53
| Facility | | $530.53 | $530.53 | $530.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.47 / $504.78 / $826.80
| Professional | | $332.47 | $504.78 | $826.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,466.20 / $11,500.00 / $16,394.00
| Facility | | $1,466.20 | $11,500.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,304.80 / $3,354.56 / $3,882.23
| Professional | | $2,304.80 | $3,354.56 | $3,882.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $314.39 / $468.67 / $724.14
| Facility | | $314.39 | $468.67 | $724.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.91 / $572.16 / $809.89
| Professional | | $399.91 | $572.16 | $809.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.07 / $467.70 / $704.14
| Professional | | $316.07 | $467.70 | $704.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.58 / $470.60 / $729.04
| Facility | | $316.58 | $470.60 | $729.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.49 / $526.99 / $874.24
| Professional | | $338.49 | $526.99 | $874.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.00 / $3,326.00 / $7,600.00
| Facility | | $1,154.00 | $3,326.00 | $7,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.28 / $484.53 / $762.50
| Professional | | $358.28 | $484.53 | $762.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.01 / $433.06 / $609.66
| Professional | | $384.01 | $433.06 | $609.66 |