- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $517.64 / $2,500.00 / $7,495.00
| Facility | | $517.64 | $2,500.00 | $7,495.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.41 / $411.67 / $602.13
| Professional | | $281.41 | $411.67 | $602.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,734.91 / $7,324.30 / $14,745.61
| Facility | | $3,734.91 | $7,324.30 | $14,745.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.39 / $400.98 / $671.85
| Professional | | $264.39 | $400.98 | $671.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.64 / $257.64 / $418.83
| Facility | | $257.64 | $257.64 | $418.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $3,533.90 / $4,187.68
| Facility | | $1,770.00 | $3,533.90 | $4,187.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.38 / $483.58 / $794.03
| Professional | | $311.38 | $483.58 | $794.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,021.28 / $11,500.00 / $16,394.00
| Facility | | $2,021.28 | $11,500.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,140.16 / $3,149.44 / $3,657.23
| Professional | | $2,140.16 | $3,149.44 | $3,657.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.01 / $439.88 / $746.63
| Facility | | $293.01 | $439.88 | $746.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.15 / $532.46 / $761.56
| Professional | | $372.15 | $532.46 | $761.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $425.30 / $1,162.40
| Professional | | $5.00 | $425.30 | $1,162.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.14 / $443.83 / $821.00
| Facility | | $294.14 | $443.83 | $821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.69 / $520.60 / $934.83
| Professional | | $328.69 | $520.60 | $934.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,093.00 / $5,870.00 / $13,237.00
| Facility | | $2,093.00 | $5,870.00 | $13,237.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.79 / $466.07 / $744.54
| Professional | | $346.79 | $466.07 | $744.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.09 / $422.52 / $573.40
| Professional | | $361.09 | $422.52 | $573.40 |