- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $445.52 / $3,102.00 / $10,546.00
| Facility | | $445.52 | $3,102.00 | $10,546.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.59 / $327.10 / $454.42
| Professional | | $252.59 | $327.10 | $454.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,393.03 / $4,323.20 / $8,313.84
| Facility | | $2,393.03 | $4,323.20 | $8,313.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.67 / $323.32 / $501.74
| Professional | | $232.67 | $323.32 | $501.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.38 / $228.38 / $228.38
| Facility | | $228.38 | $228.38 | $228.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,280.46 / $2,280.46 / $2,280.46
| Facility | | $2,280.46 | $2,280.46 | $2,280.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.08 / $421.91 / $626.78
| Professional | | $283.08 | $421.91 | $626.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,210.54 / $26,542.00 / $26,542.00
| Facility | | $1,210.54 | $26,542.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,761.28 / $2,534.56 / $2,899.05
| Professional | | $1,761.28 | $2,534.56 | $2,899.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.83 / $394.45 / $726.39
| Facility | | $275.83 | $394.45 | $726.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.38 / $428.49 / $576.82
| Professional | | $315.38 | $428.49 | $576.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.94 / $605.22 / $1,257.89
| Professional | | $413.94 | $605.22 | $1,257.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $276.39 / $401.24 / $787.51
| Facility | | $276.39 | $401.24 | $787.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.16 / $432.18 / $726.38
| Professional | | $286.16 | $432.18 | $726.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,634.00 / $4,345.00 / $10,600.00
| Facility | | $1,634.00 | $4,345.00 | $10,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.99 / $386.52 / $618.26
| Professional | | $295.99 | $386.52 | $618.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.31 / $318.14 / $443.38
| Professional | | $281.31 | $318.14 | $443.38 |