- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $582.42 / $3,589.00 / $8,240.00
| Facility | | $582.42 | $3,589.00 | $8,240.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.48 / $506.65 / $670.86
| Professional | | $379.48 | $506.65 | $670.86 |
- 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
- $557.88 / $578.92 / $578.92
| Professional | | $557.88 | $578.92 | $578.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $701.30 / $701.30 / $701.30
| Facility | | $701.30 | $701.30 | $701.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.04 / $591.91 / $1,007.50
| Professional | | $421.04 | $591.91 | $1,007.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $656.59 / $868.10 / $1,134.10
| Professional | | $656.59 | $868.10 | $1,134.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,935.90 / $6,935.90 / $6,935.90
| Facility | | $6,935.90 | $6,935.90 | $6,935.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $4,597.00 / $8,404.00
| Facility | | $1,013.00 | $4,597.00 | $8,404.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.06 / $582.42 / $2,191.65
| Professional | | $397.06 | $582.42 | $2,191.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.10 / $719.10 / $1,228.80
| Professional | | $719.10 | $719.10 | $1,228.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $701.30 / $701.30 / $701.30
| Facility | | $701.30 | $701.30 | $701.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.66 / $603.91 / $1,054.11
| Professional | | $421.66 | $603.91 | $1,054.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $399.24 / $503.20 / $596.03
| Facility | | $399.24 | $503.20 | $596.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.02 / $535.97 / $580.36
| Professional | | $399.02 | $535.97 | $580.36 |
- 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
- $549.50 / $705.05 / $1,118.84
| Professional | | $549.50 | $705.05 | $1,118.84 |