- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $525.32 / $8,920.00 / $18,862.00
| Facility | | $525.32 | $8,920.00 | $18,862.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.44 / $466.97 / $681.06
| Professional | | $381.44 | $466.97 | $681.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,966.61 / $33,300.96 / $46,381.49
| Facility | | $14,966.61 | $33,300.96 | $46,381.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.16 / $485.02 / $676.98
| Professional | | $381.16 | $485.02 | $676.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.03 / $520.70 / $1,015.37
| Professional | | $507.03 | $520.70 | $1,015.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.38 / $563.04 / $970.61
| Professional | | $413.38 | $563.04 | $970.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.34 / $469.61 / $579.17
| Professional | | $391.34 | $469.61 | $579.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $430.03 / $553.07 / $842.50
| Facility | | $430.03 | $553.07 | $842.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.00 / $747.00 / $965.21
| Professional | | $528.00 | $747.00 | $965.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $424.52 / $556.12 / $3,658.00
| Facility | | $424.52 | $556.12 | $3,658.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.52 / $556.12 / $3,658.00
| Professional | | $424.52 | $556.12 | $3,658.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,547.00 / $3,130.00 / $5,226.00
| Facility | | $1,547.00 | $3,130.00 | $5,226.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.20 / $609.58 / $946.15
| Professional | | $375.20 | $609.58 | $946.15 |