- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $413.42 / $2,496.00 / $7,542.00
| Facility | | $413.42 | $2,496.00 | $7,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.55 / $354.00 / $506.52
| Professional | | $259.55 | $354.00 | $506.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,881.72 / $3,928.93 / $7,696.71
| Facility | | $1,881.72 | $3,928.93 | $7,696.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.97 / $340.20 / $568.16
| Professional | | $245.97 | $340.20 | $568.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.33 / $238.33 / $355.88
| Facility | | $238.33 | $238.33 | $355.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,508.82 / $1,924.45 / $2,355.06
| Facility | | $1,508.82 | $1,924.45 | $2,355.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.56 / $416.03 / $676.00
| Professional | | $281.56 | $416.03 | $676.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,828.68 / $11,500.00 / $16,394.00
| Facility | | $1,828.68 | $11,500.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,933.36 / $2,613.36 / $3,037.73
| Professional | | $1,933.36 | $2,613.36 | $3,037.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $266.91 / $379.36 / $646.12
| Facility | | $266.91 | $379.36 | $646.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.83 / $456.66 / $632.29
| Professional | | $336.83 | $456.66 | $632.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $397.60 / $972.80
| Professional | | $5.00 | $397.60 | $972.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.45 / $382.30 / $740.91
| Facility | | $267.45 | $382.30 | $740.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.25 / $456.04 / $786.80
| Professional | | $298.25 | $456.04 | $786.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.00 / $2,045.00 / $4,480.00
| Facility | | $593.00 | $2,045.00 | $4,480.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.72 / $397.71 / $613.66
| Professional | | $295.72 | $397.71 | $613.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.81 / $350.75 / $475.92
| Professional | | $299.81 | $350.75 | $475.92 |