- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.20 / $1,932.00 / $3,469.00
| Facility | | $460.20 | $1,932.00 | $3,469.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.31 / $406.66 / $739.03
| Professional | | $292.31 | $406.66 | $739.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.56 / $2,410.09 / $16,394.00
| Facility | | $818.56 | $2,410.09 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.22 / $868.81 / $3,428.32
| Professional | | $371.22 | $868.81 | $3,428.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $413.79 / $531.72 / $948.41
| Facility | | $413.79 | $531.72 | $948.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.15 / $742.71 / $1,268.96
| Professional | | $450.15 | $742.71 | $1,268.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.00 / $652.29 / $3,111.82
| Facility | | $593.00 | $652.29 | $3,111.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.63 / $711.95 / $1,418.33
| Professional | | $359.63 | $711.95 | $1,418.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $345.30 / $754.50 / $6,679.00
| Facility | | $345.30 | $754.50 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.36 / $717.84 / $1,027.15
| Professional | | $553.36 | $717.84 | $1,027.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.61 / $932.64 / $1,463.92
| Professional | | $499.61 | $932.64 | $1,463.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,793.01 / $3,191.93 / $5,007.66
| Facility | | $2,793.01 | $3,191.93 | $5,007.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.90 / $551.27 / $897.00
| Professional | | $520.90 | $551.27 | $897.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $2,854.00 / $16,394.00
| Facility | | $1,061.00 | $2,854.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.39 / $1,129.47 / $3,428.32
| Professional | | $431.39 | $1,129.47 | $3,428.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $2,854.00 / $5,714.00
| Facility | | $1,061.00 | $2,854.00 | $5,714.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.70 / $718.14 / $1,780.08
| Professional | | $399.70 | $718.14 | $1,780.08 |