- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.41 / $5,087.00 / $8,920.00
| Facility | | $1,479.41 | $5,087.00 | $8,920.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.55 / $1,479.41 / $1,479.41
| Professional | | $381.55 | $1,479.41 | $1,479.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,032.00 / $6,548.00 / $7,221.00
| Facility | | $5,032.00 | $6,548.00 | $7,221.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.38 / $428.95 / $711.18
| Professional | | $336.38 | $428.95 | $711.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.36 / $587.36 / $640.00
| Facility | | $587.36 | $587.36 | $640.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,460.27 / $2,460.27 / $2,460.27
| Professional | | $2,460.27 | $2,460.27 | $2,460.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.28 / $571.01 / $660.49
| Professional | | $446.28 | $571.01 | $660.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.02 / $1,257.50 / $2,253.14
| Facility | | $358.02 | $1,257.50 | $2,253.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.90 / $650.41 / $984.14
| Professional | | $512.90 | $650.41 | $984.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $386.07 / $526.99 / $5,122.00
| Facility | | $386.07 | $526.99 | $5,122.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $386.07 / $526.99 / $5,122.00
| Professional | | $386.07 | $526.99 | $5,122.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,121.00 / $9,270.00 / $17,192.00
| Facility | | $5,121.00 | $9,270.00 | $17,192.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.06 / $489.74 / $747.88
| Professional | | $319.06 | $489.74 | $747.88 |