- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.67 / $2,747.00 / $7,104.00
| Facility | | $398.67 | $2,747.00 | $7,104.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.47 / $384.70 / $602.29
| Professional | | $248.47 | $384.70 | $602.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.35 / $6,182.00 / $17,094.48
| Facility | | $5,058.35 | $6,182.00 | $17,094.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.55 / $426.04 / $776.92
| Professional | | $410.55 | $426.04 | $776.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.36 / $464.36 / $464.36
| Facility | | $464.36 | $464.36 | $464.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.01 / $410.22 / $716.17
| Professional | | $273.01 | $410.22 | $716.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $490.82 / $653.05 / $847.78
| Professional | | $490.82 | $653.05 | $847.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,015.40 / $4,367.04 / $6,783.68
| Facility | | $2,015.40 | $4,367.04 | $6,783.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.16 / $281.62 / $448.29
| Professional | | $252.16 | $281.62 | $448.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.70 / $3,623.00 / $7,763.00
| Facility | | $454.70 | $3,623.00 | $7,763.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.12 / $405.16 / $894.74
| Professional | | $255.12 | $405.16 | $894.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.30 / $457.30 / $931.10
| Professional | | $457.30 | $457.30 | $931.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.36 / $464.36 / $464.36
| Facility | | $464.36 | $464.36 | $464.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.26 / $425.63 / $744.68
| Professional | | $273.26 | $425.63 | $744.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $264.02 / $358.10 / $430.49
| Facility | | $264.02 | $358.10 | $430.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.19 / $398.11 / $434.31
| Professional | | $263.19 | $398.11 | $434.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,334.00 / $2,824.00 / $5,678.00
| Facility | | $1,334.00 | $2,824.00 | $5,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.55 / $485.07 / $789.90
| Professional | | $374.55 | $485.07 | $789.90 |