- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $451.11 / $3,184.00 / $9,961.00
| Facility | | $451.11 | $3,184.00 | $9,961.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.57 / $403.75 / $650.10
| Professional | | $226.57 | $403.75 | $650.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,976.14 / $3,617.47 / $7,026.24
| Facility | | $1,976.14 | $3,617.47 | $7,026.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.65 / $409.92 / $616.58
| Professional | | $228.65 | $409.92 | $616.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $227.24 / $2,869.92 / $2,869.92
| Facility | | $227.24 | $2,869.92 | $2,869.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $421.91 / $421.91 / $421.91
| Facility | | $421.91 | $421.91 | $421.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.82 / $451.36 / $792.59
| Professional | | $267.82 | $451.36 | $792.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.32 / $11,500.00 / $26,542.00
| Facility | | $1,157.32 | $11,500.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,801.68 / $3,333.44 / $3,945.08
| Professional | | $1,801.68 | $3,333.44 | $3,945.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $237.16 / $440.26 / $721.76
| Facility | | $237.16 | $440.26 | $721.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.89 / $520.03 / $813.96
| Professional | | $317.89 | $520.03 | $813.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.03 / $440.50 / $641.70
| Professional | | $343.03 | $440.50 | $641.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.49 / $443.84 / $735.71
| Facility | | $238.49 | $443.84 | $735.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.67 / $486.52 / $877.05
| Professional | | $270.67 | $486.52 | $877.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,273.00 / $4,063.00 / $8,959.00
| Facility | | $1,273.00 | $4,063.00 | $8,959.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.36 / $507.14 / $802.54
| Professional | | $375.36 | $507.14 | $802.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.94 / $433.40 / $611.66
| Professional | | $385.94 | $433.40 | $611.66 |