- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $273.60 / $9,639.00 / $20,509.00
| Facility | | $273.60 | $9,639.00 | $20,509.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.04 / $273.60 / $1,419.30
| Professional | | $242.04 | $273.60 | $1,419.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,314.00 / $10,117.00 / $20,418.00
| Facility | | $4,314.00 | $10,117.00 | $20,418.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.92 / $456.69 / $823.18
| Professional | | $329.92 | $456.69 | $823.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.20 / $100.00 / $7,121.41
| Facility | | $64.20 | $100.00 | $7,121.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.97 / $332.40 / $820.69
| Professional | | $216.97 | $332.40 | $820.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.80 / $352.22 / $1,002.76
| Professional | | $275.80 | $352.22 | $1,002.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.64 / $367.45 / $699.25
| Professional | | $282.64 | $367.45 | $699.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.80 / $340.60 / $601.39
| Professional | | $261.80 | $340.60 | $601.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,814.75 / $2,227.67
| Facility | | $55.00 | $1,814.75 | $2,227.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,720.00 / $2,720.00 / $2,720.00
| Professional | | $2,720.00 | $2,720.00 | $2,720.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $273.60 / $357.31 / $560.39
| Facility | | $273.60 | $357.31 | $560.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.80 / $352.71 / $763.79
| Professional | | $275.80 | $352.71 | $763.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $880.63 / $880.63 / $880.63
| Professional | | $880.63 | $880.63 | $880.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.91 / $312.77 / $1,188.72
| Professional | | $255.91 | $312.77 | $1,188.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,732.00 / $5,067.00 / $20,279.00
| Facility | | $1,732.00 | $5,067.00 | $20,279.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.59 / $342.72 / $904.07
| Professional | | $235.59 | $342.72 | $904.07 |