- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $305.23 / $6,461.00 / $14,482.00
| Facility | | $305.23 | $6,461.00 | $14,482.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.23 / $499.51 / $739.32
| Professional | | $305.23 | $499.51 | $739.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,060.00 / $7,344.00 / $10,517.23
| Facility | | $5,060.00 | $7,344.00 | $10,517.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.74 / $1,127.02 / $3,347.39
| Professional | | $496.74 | $1,127.02 | $3,347.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $680.31 / $680.31 / $680.31
| Professional | | $680.31 | $680.31 | $680.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $305.23 / $510.79 / $915.17
| Facility | | $305.23 | $510.79 | $915.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $544.84 / $7,600.80 / $12,631.00
| Facility | | $544.84 | $7,600.80 | $12,631.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $601.70 / $1,644.57 / $2,819.10
| Professional | | $601.70 | $1,644.57 | $2,819.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $50.00 / $70.00
| Professional | | $50.00 | $50.00 | $70.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $305.23 / $510.79 / $915.17
| Facility | | $305.23 | $510.79 | $915.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $618.48 / $1,135.08 / $1,634.13
| Professional | | $618.48 | $1,135.08 | $1,634.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,082.10 / $11,082.10 / $11,082.10
| Facility | | $11,082.10 | $11,082.10 | $11,082.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,085.44 / $3,708.24 / $3,708.24
| Professional | | $2,085.44 | $3,708.24 | $3,708.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,241.00 / $9,837.00 / $12,062.00
| Facility | | $6,241.00 | $9,837.00 | $12,062.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $569.53 / $1,644.57 / $2,566.23
| Professional | | $569.53 | $1,644.57 | $2,566.23 |