- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $7,943.28 / $17,378.01
| Facility | | $891.25 | $7,943.28 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $501.19 / $1,230.27
| Professional | | $407.38 | $501.19 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $812.83 / $1,202.26
| Professional | | $467.74 | $812.83 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $977.24 / $1,148.15
| Professional | | $758.58 | $977.24 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $758.58 / $1,348.96
| Facility | | $457.09 | $758.58 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $831.76 / $1,202.26
| Professional | | $691.83 | $831.76 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $870.96 / $912.01
| Facility | | $741.31 | $870.96 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $724.44 / $1,047.13
| Facility | | $457.09 | $724.44 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $851.14 / $1,202.26
| Professional | | $79.43 | $851.14 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $10,000.00 / $26,302.68
| Facility | | $3,630.78 | $10,000.00 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $933.25 / $1,318.26
| Professional | | $812.83 | $933.25 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $16,218.10 / $23,988.33
| Facility | | $2,884.03 | $16,218.10 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $870.96 / $1,230.27
| Professional | | $588.84 | $870.96 | $1,230.27 |