- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $705.89 / $3,445.00 / $10,836.00
| Facility | | $705.89 | $3,445.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.98 / $599.59 / $817.27
| Professional | | $465.98 | $599.59 | $817.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,997.44 / $7,275.80 / $14,454.58
| Facility | | $3,997.44 | $7,275.80 | $14,454.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.73 / $586.17 / $971.55
| Professional | | $425.73 | $586.17 | $971.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.37 / $223.37 / $410.58
| Facility | | $223.37 | $223.37 | $410.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,187.68 / $4,187.68 / $4,187.68
| Facility | | $4,187.68 | $4,187.68 | $4,187.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.61 / $711.40 / $1,149.05
| Professional | | $508.61 | $711.40 | $1,149.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,213.06 / $26,542.00 / $26,542.00
| Facility | | $3,213.06 | $26,542.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,413.12 / $4,460.56 / $5,134.80
| Professional | | $3,413.12 | $4,460.56 | $5,134.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $487.35 / $705.89 / $1,322.64
| Facility | | $487.35 | $705.89 | $1,322.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.23 / $775.83 / $1,074.22
| Professional | | $591.23 | $775.83 | $1,074.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $667.80 / $667.80 / $667.80
| Professional | | $667.80 | $667.80 | $667.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $487.35 / $716.41 / $1,335.77
| Facility | | $487.35 | $716.41 | $1,335.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.36 / $734.98 / $1,279.32
| Professional | | $520.36 | $734.98 | $1,279.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,093.00 / $6,000.00 / $13,134.00
| Facility | | $2,093.00 | $6,000.00 | $13,134.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.21 / $707.04 / $1,127.59
| Professional | | $514.21 | $707.04 | $1,127.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $509.34 / $575.96 / $808.49
| Professional | | $509.34 | $575.96 | $808.49 |