- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,516.00 / $5,845.00 / $10,686.00
| Facility | | $1,516.00 | $5,845.00 | $10,686.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.73 / $770.48 / $864.89
| Professional | | $483.73 | $770.48 | $864.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,100.00 / $7,264.00 / $12,274.00
| Facility | | $4,100.00 | $7,264.00 | $12,274.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.12 / $465.31 / $1,219.34
| Professional | | $373.12 | $465.31 | $1,219.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $283.02 / $283.02 / $7,227.90
| Facility | | $283.02 | $283.02 | $7,227.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.47 / $1,178.68 / $1,178.68
| Professional | | $236.47 | $1,178.68 | $1,178.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.53 / $348.79 / $501.88
| Professional | | $232.53 | $348.79 | $501.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $283.02 / $555.00 / $7,227.90
| Facility | | $283.02 | $555.00 | $7,227.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,913.50 / $1,913.50 / $1,970.91
| Professional | | $1,913.50 | $1,913.50 | $1,970.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,337.00 / $6,450.00 / $12,742.00
| Facility | | $2,337.00 | $6,450.00 | $12,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.31 / $867.57 / $1,951.17
| Professional | | $305.31 | $867.57 | $1,951.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.24 / $239.24 / $239.24
| Facility | | $239.24 | $239.24 | $239.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.24 / $337.16 / $501.88
| Professional | | $239.24 | $337.16 | $501.88 |