- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $509.87 / $2,496.00 / $7,316.00
| Facility | | $509.87 | $2,496.00 | $7,316.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.29 / $431.54 / $600.62
| Professional | | $263.29 | $431.54 | $600.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,627.85 / $2,834.48 / $5,863.83
| Facility | | $1,627.85 | $2,834.48 | $5,863.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.45 / $429.51 / $705.17
| Professional | | $248.45 | $429.51 | $705.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $545.00 / $2,075.35 / $5,461.00
| Facility | | $545.00 | $2,075.35 | $5,461.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.92 / $238.92 / $238.92
| Facility | | $238.92 | $238.92 | $238.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,377.85 / $1,377.85 / $1,377.85
| Facility | | $1,377.85 | $1,377.85 | $1,377.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.69 / $497.42 / $819.57
| Professional | | $294.69 | $497.42 | $819.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,323.07 / $16,394.00 / $16,394.00
| Facility | | $1,323.07 | $16,394.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,314.00 / $3,769.05 / $4,922.22
| Professional | | $2,314.00 | $3,769.05 | $4,922.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $287.92 / $500.92 / $962.36
| Facility | | $287.92 | $500.92 | $962.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.29 / $489.74 / $786.60
| Professional | | $342.29 | $489.74 | $786.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $976.10 / $976.10 / $976.10
| Professional | | $976.10 | $976.10 | $976.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.12 / $507.02 / $986.94
| Facility | | $288.12 | $507.02 | $986.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.19 / $504.07 / $881.01
| Professional | | $302.19 | $504.07 | $881.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.00 / $3,226.00 / $7,600.00
| Facility | | $1,154.00 | $3,226.00 | $7,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.98 / $503.23 / $814.76
| Professional | | $356.98 | $503.23 | $814.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.97 / $421.99 / $591.41
| Professional | | $372.97 | $421.99 | $591.41 |