- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $8,511.38 / $14,454.40
| Facility | | $7,244.36 | $8,511.38 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $251.19 / $269.15
| Professional | | $218.78 | $251.19 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $9,549.93 / $18,620.87
| Facility | | $7,244.36 | $9,549.93 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $331.13 / $467.74
| Professional | | $194.98 | $331.13 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $501.19 / $630.96
| Professional | | $478.63 | $501.19 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $457.09 / $8,709.64
| Facility | | $251.19 | $457.09 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $562.34 / $1,000.00
| Professional | | $316.23 | $562.34 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $512.86 / $645.65
| Professional | | $446.68 | $512.86 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $478.63 / $630.96
| Professional | | $446.68 | $478.63 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $6,606.93 / $8,912.51
| Facility | | $3,548.13 | $6,606.93 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $537.03 / $794.33
| Professional | | $302.00 | $537.03 | $794.33 |