- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $422.47 / $2,938.00 / $7,763.00
| Facility | | $422.47 | $2,938.00 | $7,763.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.27 / $362.74 / $468.13
| Professional | | $244.27 | $362.74 | $468.13 |
- 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
- $391.53 / $406.31 / $406.31
| Professional | | $391.53 | $406.31 | $406.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.74 / $448.74 / $448.74
| Facility | | $448.74 | $448.74 | $448.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.85 / $391.65 / $699.08
| Professional | | $262.85 | $391.65 | $699.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.88 / $619.85 / $806.44
| Professional | | $466.88 | $619.85 | $806.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.66 / $303.66 / $405.39
| Professional | | $303.66 | $303.66 | $405.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $768.00 / $3,838.00 / $8,017.00
| Facility | | $768.00 | $3,838.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.52 / $383.17 / $1,068.00
| Professional | | $247.52 | $383.17 | $1,068.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $420.46 / $460.60 / $905.10
| Professional | | $420.46 | $460.60 | $905.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.74 / $448.74 / $448.74
| Facility | | $448.74 | $448.74 | $448.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.52 / $403.88 / $717.88
| Professional | | $267.52 | $403.88 | $717.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $256.82 / $364.55 / $439.72
| Facility | | $256.82 | $364.55 | $439.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.04 / $382.86 / $417.25
| Professional | | $256.04 | $382.86 | $417.25 |
- 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
- $365.66 / $498.43 / $795.91
| Professional | | $365.66 | $498.43 | $795.91 |