- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $518.03 / $7,920.26 / $30,593.00
| Facility | | $518.03 | $7,920.26 | $30,593.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.41 / $388.23 / $1,066.75
| Professional | | $222.41 | $388.23 | $1,066.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,664.70 / $1,664.70 / $2,400.80
| Facility | | $1,664.70 | $1,664.70 | $2,400.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.10 / $569.91 / $1,065.25
| Professional | | $309.10 | $569.91 | $1,065.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.38 / $632.41 / $967.74
| Professional | | $449.38 | $632.41 | $967.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.07 / $546.00 / $863.48
| Facility | | $306.07 | $546.00 | $863.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.20 / $555.64 / $952.21
| Professional | | $379.20 | $555.64 | $952.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $388.10 / $646.83 / $800.65
| Facility | | $388.10 | $646.83 | $800.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.37 / $611.28 / $1,029.72
| Facility | | $306.37 | $611.28 | $1,029.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.40 / $638.22 / $1,021.28
| Professional | | $428.40 | $638.22 | $1,021.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,382.73 / $9,721.75 / $12,052.68
| Facility | | $7,382.73 | $9,721.75 | $12,052.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.00 / $661.36 / $1,076.60
| Professional | | $435.00 | $661.36 | $1,076.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,533.00 / $8,090.00 / $12,786.00
| Facility | | $1,533.00 | $8,090.00 | $12,786.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.40 / $704.45 / $1,243.21
| Professional | | $478.40 | $704.45 | $1,243.21 |