- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $262.08 / $2,561.00 / $6,012.00
| Facility | | $262.08 | $2,561.00 | $6,012.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.34 / $1,810.89 / $5,084.45
| Professional | | $204.34 | $1,810.89 | $5,084.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $8,639.91 / $79,506.39
| Facility | | $5,000.00 | $8,639.91 | $79,506.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,620.40 / $4,182.89 / $7,809.20
| Professional | | $2,620.40 | $4,182.89 | $7,809.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $369.23 / $369.23 / $369.23
| Facility | | $369.23 | $369.23 | $369.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.74 / $500.87 / $6,316.03
| Professional | | $233.74 | $500.87 | $6,316.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,228.14 / $4,317.72 / $5,575.87
| Professional | | $3,228.14 | $4,317.72 | $5,575.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.43 / $1,996.67 / $13,089.87
| Facility | | $1,584.43 | $1,996.67 | $13,089.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.42 / $228.42 / $228.42
| Professional | | $228.42 | $228.42 | $228.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.58 / $2,667.00 / $7,197.00
| Facility | | $307.58 | $2,667.00 | $7,197.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.75 / $1,810.89 / $7,033.23
| Professional | | $212.75 | $1,810.89 | $7,033.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.50 / $250.50 / $6,717.70
| Professional | | $250.50 | $250.50 | $6,717.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $369.23 / $369.23 / $369.23
| Facility | | $369.23 | $369.23 | $369.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.74 / $589.50 / $6,377.50
| Professional | | $233.74 | $589.50 | $6,377.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.60 / $254.65 / $4,613.24
| Facility | | $212.60 | $254.65 | $4,613.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.60 / $2,775.18 / $3,104.83
| Professional | | $212.60 | $2,775.18 | $3,104.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.00 / $650.00 / $4,430.00
| Facility | | $162.00 | $650.00 | $4,430.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,428.98 / $4,571.97 / $7,334.95
| Professional | | $3,428.98 | $4,571.97 | $7,334.95 |