- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $611.26 / $3,996.00 / $9,038.00
| Facility | | $611.26 | $3,996.00 | $9,038.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.11 / $500.49 / $876.68
| Professional | | $385.11 | $500.49 | $876.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,283.00 / $5,160.00 / $11,809.00
| Facility | | $3,283.00 | $5,160.00 | $11,809.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.87 / $409.64 / $1,086.15
| Professional | | $329.87 | $409.64 | $1,086.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.79 / $587.79 / $587.79
| Facility | | $587.79 | $587.79 | $587.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $587.79 / $587.79 / $587.79
| Professional | | $587.79 | $587.79 | $587.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $536.69 / $536.69 / $9,122.79
| Facility | | $536.69 | $536.69 | $9,122.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.45 / $731.46 / $1,597.83
| Professional | | $309.45 | $731.46 | $1,597.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.00 / $534.16 / $1,238.22
| Facility | | $332.00 | $534.16 | $1,238.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.32 / $645.22 / $965.61
| Professional | | $550.32 | $645.22 | $965.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.67 / $444.98 / $876.03
| Professional | | $362.67 | $444.98 | $876.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $536.69 / $555.00 / $9,122.79
| Facility | | $536.69 | $555.00 | $9,122.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.30 / $712.32 / $1,597.83
| Professional | | $370.30 | $712.32 | $1,597.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,264.00 / $5,735.00 / $11,200.00
| Facility | | $2,264.00 | $5,735.00 | $11,200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.41 / $533.98 / $1,170.26
| Professional | | $267.41 | $533.98 | $1,170.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $509.71 / $509.71 / $529.58
| Facility | | $509.71 | $509.71 | $529.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.67 / $509.71 / $1,011.35
| Professional | | $362.67 | $509.71 | $1,011.35 |