- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.20 / $2,562.00 / $7,542.00
| Facility | | $477.20 | $2,562.00 | $7,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.22 / $338.60 / $517.37
| Professional | | $219.22 | $338.60 | $517.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,243.28 / $4,243.05 / $8,279.29
| Facility | | $2,243.28 | $4,243.05 | $8,279.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.03 / $336.32 / $491.43
| Professional | | $215.03 | $336.32 | $491.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $217.67 / $217.67
| Facility | | $80.00 | $217.67 | $217.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.99 / $400.99 / $400.99
| Facility | | $400.99 | $400.99 | $400.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.77 / $408.20 / $668.85
| Professional | | $256.77 | $408.20 | $668.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,115.08 / $11,500.00 / $16,394.00
| Facility | | $1,115.08 | $11,500.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,751.04 / $2,650.56 / $3,040.43
| Professional | | $1,751.04 | $2,650.56 | $3,040.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.52 / $377.87 / $581.05
| Facility | | $243.52 | $377.87 | $581.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.50 / $431.37 / $636.97
| Professional | | $301.50 | $431.37 | $636.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.60 / $463.60 / $463.60
| Professional | | $463.60 | $463.60 | $463.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.52 / $378.32 / $596.57
| Facility | | $243.52 | $378.32 | $596.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.32 / $423.36 / $707.47
| Professional | | $261.32 | $423.36 | $707.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.00 / $3,451.00 / $7,600.00
| Facility | | $1,154.00 | $3,451.00 | $7,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.17 / $403.98 / $646.40
| Professional | | $301.17 | $403.98 | $646.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.02 / $340.66 / $480.10
| Professional | | $302.02 | $340.66 | $480.10 |