- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $430.85 / $1,813.40 / $7,197.00
| Facility | | $430.85 | $1,813.40 | $7,197.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.05 / $369.43 / $629.29
| Professional | | $238.05 | $369.43 | $629.29 |
- 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
- $402.61 / $417.80 / $747.22
| Professional | | $402.61 | $417.80 | $747.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $452.86 / $452.86 / $452.86
| Facility | | $452.86 | $452.86 | $452.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.49 / $392.69 / $697.04
| Professional | | $257.49 | $392.69 | $697.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.99 / $639.91 / $830.79
| Professional | | $480.99 | $639.91 | $830.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,759.71 / $5,759.71 / $5,759.71
| Facility | | $5,759.71 | $5,759.71 | $5,759.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $2,070.00 / $8,017.00
| Facility | | $540.00 | $2,070.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.16 / $407.72 / $1,023.00
| Professional | | $244.16 | $407.72 | $1,023.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.10 / $427.10 / $896.60
| Professional | | $427.10 | $427.10 | $896.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $452.86 / $452.86 / $452.86
| Facility | | $452.86 | $452.86 | $452.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.31 / $408.62 / $727.74
| Professional | | $265.31 | $408.62 | $727.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.36 / $342.32 / $418.18
| Facility | | $257.36 | $342.32 | $418.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.85 / $390.35 / $425.95
| Professional | | $256.85 | $390.35 | $425.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,175.00 / $2,715.00 / $5,678.00
| Facility | | $1,175.00 | $2,715.00 | $5,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.54 / $499.69 / $822.14
| Professional | | $363.54 | $499.69 | $822.14 |