- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $465.96 / $3,445.00 / $10,836.00
| Facility | | $465.96 | $3,445.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.47 / $440.73 / $709.63
| Professional | | $282.47 | $440.73 | $709.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,761.03 / $3,135.02 / $6,734.50
| Facility | | $1,761.03 | $3,135.02 | $6,734.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.94 / $417.99 / $598.73
| Professional | | $267.94 | $417.99 | $598.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.87 / $253.87 / $459.81
| Facility | | $253.87 | $253.87 | $459.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,263.04 / $1,263.04 / $1,304.32
| Facility | | $1,263.04 | $1,263.04 | $1,304.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.00 / $443.67 / $670.68
| Professional | | $294.00 | $443.67 | $670.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $2,017.08
| Facility | | $55.00 | $55.00 | $2,017.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.28 / $3,234.80 / $3,740.03
| Professional | | $2,137.28 | $3,234.80 | $3,740.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.08 / $458.94 / $698.37
| Facility | | $292.08 | $458.94 | $698.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.12 / $483.91 / $736.85
| Professional | | $313.12 | $483.91 | $736.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.45 / $522.07 / $1,067.86
| Professional | | $295.45 | $522.07 | $1,067.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.08 / $461.15 / $765.80
| Facility | | $292.08 | $461.15 | $765.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.64 / $450.44 / $692.65
| Professional | | $298.64 | $450.44 | $692.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,120.00 / $3,264.00 / $7,600.00
| Facility | | $1,120.00 | $3,264.00 | $7,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.88 / $467.72 / $698.76
| Professional | | $352.88 | $467.72 | $698.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.93 / $415.33 / $588.40
| Professional | | $369.93 | $415.33 | $588.40 |