- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $742.17 / $3,224.00 / $11,453.00
| Facility | | $742.17 | $3,224.00 | $11,453.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.10 / $481.45 / $832.00
| Professional | | $395.10 | $481.45 | $832.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,322.94 / $2,195.73 / $4,663.00
| Facility | | $1,322.94 | $2,195.73 | $4,663.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.46 / $526.87 / $739.01
| Professional | | $428.46 | $526.87 | $739.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $429.45 / $431.61
| Facility | | $80.00 | $429.45 | $431.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.02 / $537.02 / $537.02
| Facility | | $537.02 | $537.02 | $537.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.59 / $642.53 / $986.77
| Professional | | $462.59 | $642.53 | $986.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,174.94 / $11,500.00 / $26,542.00
| Facility | | $2,174.94 | $11,500.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,569.61 / $3,687.40 / $3,901.05
| Professional | | $3,569.61 | $3,687.40 | $3,901.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $449.80 / $585.90 / $895.64
| Facility | | $449.80 | $585.90 | $895.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.76 / $690.92 / $856.73
| Professional | | $575.76 | $690.92 | $856.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.02 / $520.67 / $668.40
| Professional | | $476.02 | $520.67 | $668.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $449.80 / $585.94 / $923.03
| Facility | | $449.80 | $585.94 | $923.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.36 / $657.71 / $1,006.76
| Professional | | $468.36 | $657.71 | $1,006.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,391.00 / $4,063.00 / $8,226.00
| Facility | | $1,391.00 | $4,063.00 | $8,226.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.49 / $516.87 / $814.94
| Professional | | $390.49 | $516.87 | $814.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.12 / $449.80 / $624.00
| Professional | | $393.12 | $449.80 | $624.00 |