- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $533.85 / $2,128.00 / $7,408.00
| Facility | | $533.85 | $2,128.00 | $7,408.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $479.72 / $640.15 / $1,016.55
| Professional | | $479.72 | $640.15 | $1,016.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.75 / $463.54 / $520.83
| Professional | | $306.75 | $463.54 | $520.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.77 / $391.89 / $1,567.58
| Facility | | $228.77 | $391.89 | $1,567.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.27 / $570.76 / $805.04
| Professional | | $453.27 | $570.76 | $805.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.94 / $466.36 / $517.33
| Facility | | $417.94 | $466.36 | $517.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.41 / $352.41 / $363.93
| Facility | | $352.41 | $352.41 | $363.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $493.94 / $655.37 / $1,423.00
| Professional | | $493.94 | $655.37 | $1,423.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $3,956.96
| Facility | | $55.00 | $55.00 | $3,956.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,914.76 / $4,736.35 / $5,641.13
| Professional | | $3,914.76 | $4,736.35 | $5,641.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.65 / $775.43 / $1,413.61
| Facility | | $497.65 | $775.43 | $1,413.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.60 / $718.10 / $863.87
| Professional | | $526.60 | $718.10 | $863.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.16 / $986.24 / $1,234.31
| Professional | | $482.16 | $986.24 | $1,234.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.65 / $778.20 / $1,439.73
| Facility | | $497.65 | $778.20 | $1,439.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.09 / $685.92 / $1,385.60
| Professional | | $506.09 | $685.92 | $1,385.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.00 / $1,500.00 / $3,287.00
| Facility | | $371.00 | $1,500.00 | $3,287.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.67 / $599.04 / $1,171.47
| Professional | | $435.67 | $599.04 | $1,171.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.70 / $491.35 / $689.09
| Professional | | $433.70 | $491.35 | $689.09 |