- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $836.72 / $3,620.00 / $12,040.00
| Facility | | $836.72 | $3,620.00 | $12,040.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.53 / $572.66 / $786.01
| Professional | | $492.53 | $572.66 | $786.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,639.19 / $6,643.64 / $12,314.01
| Facility | | $3,639.19 | $6,643.64 | $12,314.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $481.17 / $504.15 / $581.44
| Professional | | $481.17 | $504.15 | $581.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.96 / $478.96 / $478.96
| Facility | | $478.96 | $478.96 | $478.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,619.61 / $3,619.61 / $3,619.61
| Facility | | $3,619.61 | $3,619.61 | $3,619.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.36 / $716.67 / $1,110.78
| Professional | | $548.36 | $716.67 | $1,110.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,500.00 / $26,542.00 / $26,542.00
| Facility | | $11,500.00 | $26,542.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,895.44 / $3,983.12 / $4,457.18
| Professional | | $3,895.44 | $3,983.12 | $4,457.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $525.84 / $683.93 / $1,176.59
| Facility | | $525.84 | $683.93 | $1,176.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.17 / $795.80 / $936.23
| Professional | | $676.17 | $795.80 | $936.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $800.90 / $800.90 / $800.90
| Professional | | $800.90 | $800.90 | $800.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $525.84 / $687.57 / $1,350.65
| Facility | | $525.84 | $687.57 | $1,350.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.36 / $726.18 / $1,120.15
| Professional | | $548.36 | $726.18 | $1,120.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,691.00 / $5,210.00 / $10,476.00
| Facility | | $1,691.00 | $5,210.00 | $10,476.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.47 / $609.77 / $982.29
| Professional | | $443.47 | $609.77 | $982.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.92 / $507.10 / $702.53
| Professional | | $443.92 | $507.10 | $702.53 |