- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $652.00 / $3,171.36 / $8,740.29
| Facility | | $652.00 | $3,171.36 | $8,740.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.30 / $578.79 / $1,308.58
| Professional | | $269.30 | $578.79 | $1,308.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.61 / $286.61 / $376.72
| Professional | | $286.61 | $286.61 | $376.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,431.95 / $7,827.00 / $19,139.18
| Facility | | $6,431.95 | $7,827.00 | $19,139.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $659.24 / $930.81 / $1,335.01
| Professional | | $659.24 | $930.81 | $1,335.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.73 / $584.44 / $1,352.26
| Professional | | $281.73 | $584.44 | $1,352.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,231.76 / $1,231.76 / $1,268.79
| Professional | | $1,231.76 | $1,231.76 | $1,268.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,295.48 / $8,575.91 / $14,536.54
| Facility | | $3,295.48 | $8,575.91 | $14,536.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.66 / $305.43 / $442.78
| Professional | | $277.66 | $305.43 | $442.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $574.00 / $2,761.92 / $8,451.00
| Facility | | $574.00 | $2,761.92 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.30 / $604.45 / $1,403.69
| Professional | | $269.30 | $604.45 | $1,403.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.08 / $735.86 / $1,511.70
| Professional | | $241.08 | $735.86 | $1,511.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.22 / $591.73 / $1,351.73
| Professional | | $292.22 | $591.73 | $1,351.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.69 / $468.07 / $1,459.11
| Facility | | $251.69 | $468.07 | $1,459.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.69 / $468.07 / $869.54
| Professional | | $251.69 | $468.07 | $869.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,440.00 / $3,475.00 / $6,000.00
| Facility | | $1,440.00 | $3,475.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.22 / $1,024.83 / $1,586.53
| Professional | | $741.22 | $1,024.83 | $1,586.53 |