- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,820.00 / $6,880.00 / $17,902.00
| Facility | | $1,820.00 | $6,880.00 | $17,902.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.37 / $348.24 / $541.49
| Professional | | $306.37 | $348.24 | $541.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,108.00 / $9,596.00 / $18,150.00
| Facility | | $4,108.00 | $9,596.00 | $18,150.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.38 / $447.81 / $701.57
| Professional | | $384.38 | $447.81 | $701.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.09 / $100.00 / $3,855.69
| Facility | | $66.09 | $100.00 | $3,855.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.35 / $273.77 / $319.27
| Professional | | $261.35 | $273.77 | $319.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.93 / $393.93 / $393.93
| Professional | | $393.93 | $393.93 | $393.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,620.70 / $1,983.05 / $2,204.69
| Facility | | $1,620.70 | $1,983.05 | $2,204.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,493.28 / $2,771.60 / $2,988.15
| Professional | | $2,493.28 | $2,771.60 | $2,988.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $410.66 / $474.81 / $578.70
| Facility | | $410.66 | $474.81 | $578.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.76 / $293.01 / $366.26
| Professional | | $265.76 | $293.01 | $366.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,116.00 / $9,759.00 / $22,073.00
| Facility | | $5,116.00 | $9,759.00 | $22,073.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.33 / $434.70 / $1,036.57
| Professional | | $293.33 | $434.70 | $1,036.57 |