- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $595.46 / $2,747.00 / $8,017.00
| Facility | | $595.46 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.68 / $485.29 / $707.22
| Professional | | $347.68 | $485.29 | $707.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,211.00 / $4,354.00 / $8,459.92
| Facility | | $2,211.00 | $4,354.00 | $8,459.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.94 / $535.41 / $919.30
| Professional | | $515.94 | $535.41 | $919.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.00 / $480.00 / $480.00
| Facility | | $480.00 | $480.00 | $480.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.44 / $473.24 / $745.18
| Professional | | $319.44 | $473.24 | $745.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $635.84 / $635.84 / $819.93
| Professional | | $635.84 | $635.84 | $819.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.22 / $459.33 / $465.69
| Professional | | $434.22 | $459.33 | $465.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $918.00 / $3,120.00 / $8,017.00
| Facility | | $918.00 | $3,120.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.75 / $521.30 / $2,001.41
| Professional | | $361.75 | $521.30 | $2,001.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $485.90 / $485.90 / $485.90
| Professional | | $485.90 | $485.90 | $485.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.00 / $480.00 / $480.00
| Facility | | $480.00 | $480.00 | $480.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.34 / $476.16 / $721.71
| Professional | | $338.34 | $476.16 | $721.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.38 / $412.55 / $517.04
| Facility | | $363.38 | $412.55 | $517.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.57 / $476.93 / $556.15
| Professional | | $360.57 | $476.93 | $556.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.00 / $2,884.00 / $6,000.00
| Facility | | $1,122.00 | $2,884.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.10 / $584.27 / $969.60
| Professional | | $440.10 | $584.27 | $969.60 |