- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $2,691.53 / $7,413.10
| Facility | | $309.03 | $2,691.53 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $275.42 / $645.65
| Professional | | $213.80 | $275.42 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,630.78 / $5,011.87
| Facility | | $1,819.70 | $3,630.78 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $257.04 / $630.96
| Professional | | $204.17 | $257.04 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $323.59 / $6,165.95
| Facility | | $323.59 | $323.59 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $323.59 / $363.08
| Professional | | $323.59 | $323.59 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $398.11 / $50,118.72
| Facility | | $34.67 | $398.11 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $380.19 / $1,000.00
| Professional | | $234.42 | $380.19 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $302.00 / $870.96
| Facility | | $257.04 | $302.00 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $446.68 / $630.96
| Professional | | $316.23 | $446.68 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $251.19 / $251.19
| Facility | | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $354.81 / $562.34
| Professional | | $223.87 | $354.81 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $794.33
| Facility | | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $309.03 / $323.59
| Professional | | $309.03 | $309.03 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $50,118.72 / $75,857.76
| Facility | | $257.04 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $398.11 / $588.84
| Professional | | $302.00 | $398.11 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,754.23 / $4,897.79
| Facility | | $831.76 | $2,754.23 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $302.00 / $741.31
| Professional | | $204.17 | $302.00 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $281.84 / $1,148.15
| Facility | | $190.55 | $281.84 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $323.59 / $741.31
| Professional | | $218.78 | $323.59 | $741.31 |