- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $353.91 / $1,746.00 / $7,175.00
| Facility | | $353.91 | $1,746.00 | $7,175.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.92 / $420.02 / $588.23
| Professional | | $291.92 | $420.02 | $588.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.20 / $496.20 / $496.20
| Professional | | $496.20 | $496.20 | $496.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $4,354.00 / $8,459.92
| Facility | | $1,350.00 | $4,354.00 | $8,459.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.27 / $574.10 / $832.35
| Professional | | $400.27 | $574.10 | $832.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.09 / $501.85 / $823.07
| Professional | | $330.09 | $501.85 | $823.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $551.13 / $731.43 / $748.21
| Professional | | $551.13 | $731.43 | $748.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,147.41 / $6,014.10 / $14,639.34
| Facility | | $1,147.41 | $6,014.10 | $14,639.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.39 / $372.39 / $372.39
| Professional | | $372.39 | $372.39 | $372.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $514.78 / $2,266.00 / $8,017.00
| Facility | | $514.78 | $2,266.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.02 / $451.95 / $1,234.00
| Professional | | $302.02 | $451.95 | $1,234.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $326.39 / $1,271.20
| Professional | | $5.00 | $326.39 | $1,271.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.14 / $513.71 / $846.29
| Professional | | $336.14 | $513.71 | $846.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.97 / $319.92 / $457.14
| Facility | | $300.97 | $319.92 | $457.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.02 / $341.84 / $492.89
| Professional | | $313.02 | $341.84 | $492.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.00 / $2,391.00 / $4,789.00
| Facility | | $912.00 | $2,391.00 | $4,789.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.11 / $554.88 / $895.31
| Professional | | $374.11 | $554.88 | $895.31 |