- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.47 / $2,079.00 / $3,685.00
| Facility | | $389.47 | $2,079.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.64 / $441.93 / $643.25
| Professional | | $372.64 | $441.93 | $643.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $2,575.00 / $5,454.00
| Facility | | $818.35 | $2,575.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.82 / $551.09 / $2,684.80
| Professional | | $292.82 | $551.09 | $2,684.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.73 / $568.16 / $1,004.15
| Facility | | $437.73 | $568.16 | $1,004.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $552.85 / $756.85 / $1,004.13
| Professional | | $552.85 | $756.85 | $1,004.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.80 / $270.80 / $270.80
| Facility | | $270.80 | $270.80 | $270.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.12 / $685.10 / $1,224.19
| Professional | | $372.12 | $685.10 | $1,224.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.32 / $558.71 / $6,679.00
| Facility | | $214.32 | $558.71 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.25 / $536.47 / $740.54
| Professional | | $428.25 | $536.47 | $740.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.79 / $909.91 / $1,274.18
| Professional | | $451.79 | $909.91 | $1,274.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.85 / $206.85 / $206.85
| Facility | | $206.85 | $206.85 | $206.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $644.66 / $644.66 / $644.66
| Professional | | $644.66 | $644.66 | $644.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,628.00 / $9,039.00
| Facility | | $55.00 | $2,628.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.89 / $597.85 / $2,818.40
| Professional | | $391.89 | $597.85 | $2,818.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,715.00 / $8,766.00
| Facility | | $1,685.00 | $3,715.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.68 / $562.62 / $1,211.40
| Professional | | $375.68 | $562.62 | $1,211.40 |