- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $611.02 / $3,162.00 / $10,836.00
| Facility | | $611.02 | $3,162.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.02 / $439.98 / $731.62
| Professional | | $295.02 | $439.98 | $731.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,664.27 / $3,057.62 / $6,192.64
| Facility | | $1,664.27 | $3,057.62 | $6,192.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.33 / $441.82 / $672.16
| Professional | | $284.33 | $441.82 | $672.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.47 / $269.47 / $481.70
| Facility | | $269.47 | $269.47 | $481.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,263.04 / $1,263.04 / $1,304.32
| Facility | | $1,263.04 | $1,263.04 | $1,304.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.14 / $464.71 / $702.55
| Professional | | $310.14 | $464.71 | $702.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,140.08 / $26,542.00 / $26,542.00
| Facility | | $2,140.08 | $26,542.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,266.80 / $3,571.45 / $3,919.73
| Professional | | $2,266.80 | $3,571.45 | $3,919.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $303.50 / $453.70 / $715.19
| Facility | | $303.50 | $453.70 | $715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.33 / $513.60 / $772.04
| Professional | | $332.33 | $513.60 | $772.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.31 / $435.24 / $569.05
| Professional | | $298.31 | $435.24 | $569.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $303.50 / $456.60 / $775.90
| Facility | | $303.50 | $456.60 | $775.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.45 / $477.20 / $726.95
| Professional | | $315.45 | $477.20 | $726.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,120.00 / $3,264.00 / $7,600.00
| Facility | | $1,120.00 | $3,264.00 | $7,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.02 / $458.74 / $669.00
| Professional | | $338.02 | $458.74 | $669.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.59 / $435.24 / $616.41
| Professional | | $387.59 | $435.24 | $616.41 |