- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.14 / $5,087.00 / $8,920.00
| Facility | | $575.14 | $5,087.00 | $8,920.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.99 / $551.17 / $588.86
| Professional | | $366.99 | $551.17 | $588.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,153.00 / $7,363.00 / $9,410.00
| Facility | | $6,153.00 | $7,363.00 | $9,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.62 / $1,172.52 / $1,657.67
| Professional | | $924.62 | $1,172.52 | $1,657.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.50 / $436.50 / $436.50
| Facility | | $436.50 | $436.50 | $436.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,992.54 / $1,992.54 / $1,992.54
| Professional | | $1,992.54 | $1,992.54 | $1,992.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.43 / $369.92 / $470.60
| Professional | | $314.43 | $369.92 | $470.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $357.88 / $468.94 / $707.42
| Facility | | $357.88 | $468.94 | $707.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.59 / $642.36 / $902.74
| Professional | | $550.59 | $642.36 | $902.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $369.98 / $648.23 / $10,945.00
| Facility | | $369.98 | $648.23 | $10,945.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.98 / $648.23 / $10,945.00
| Professional | | $369.98 | $648.23 | $10,945.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,398.00 / $10,423.00 / $21,639.00
| Facility | | $6,398.00 | $10,423.00 | $21,639.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.92 / $299.12 / $540.34
| Professional | | $209.92 | $299.12 | $540.34 |