- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $359.42 / $2,747.00 / $7,317.00
| Facility | | $359.42 | $2,747.00 | $7,317.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.27 / $345.04 / $621.67
| Professional | | $240.27 | $345.04 | $621.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,292.00 / $5,951.00 / $9,100.00
| Facility | | $3,292.00 | $5,951.00 | $9,100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.23 / $398.15 / $724.76
| Professional | | $372.23 | $398.15 | $724.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $444.78 / $444.78 / $444.78
| Facility | | $444.78 | $444.78 | $444.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.23 / $378.35 / $661.90
| Professional | | $258.23 | $378.35 | $661.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.43 / $587.88 / $764.20
| Professional | | $442.43 | $587.88 | $764.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.98 / $4,256.58 / $5,066.16
| Facility | | $2,528.98 | $4,256.58 | $5,066.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.27 / $294.95 / $384.48
| Professional | | $264.27 | $294.95 | $384.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $397.30 / $2,467.00 / $8,017.00
| Facility | | $397.30 | $2,467.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.56 / $374.04 / $818.44
| Professional | | $249.56 | $374.04 | $818.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.90 / $416.90 / $869.40
| Professional | | $416.90 | $416.90 | $869.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $444.78 / $444.78 / $444.78
| Facility | | $444.78 | $444.78 | $444.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.80 / $388.53 / $688.17
| Professional | | $261.80 | $388.53 | $688.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $254.31 / $315.32 / $402.27
| Facility | | $254.31 | $315.32 | $402.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.84 / $363.46 / $395.58
| Professional | | $253.84 | $363.46 | $395.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.00 / $2,391.00 / $4,789.00
| Facility | | $814.00 | $2,391.00 | $4,789.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.41 / $451.32 / $734.94
| Professional | | $313.41 | $451.32 | $734.94 |