- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.60 / $6,469.59 / $8,016.84
| Facility | | $523.60 | $6,469.59 | $8,016.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.33 / $324.19 / $1,203.68
| Professional | | $277.33 | $324.19 | $1,203.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,650.32 / $5,650.32 / $5,650.32
| Professional | | $5,650.32 | $5,650.32 | $5,650.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.47 / $505.22 / $718.75
| Professional | | $344.47 | $505.22 | $718.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.36 / $2,844.33 / $5,654.79
| Facility | | $495.36 | $2,844.33 | $5,654.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.23 / $438.44 / $734.88
| Professional | | $313.23 | $438.44 | $734.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $284.76 / $388.00 / $571.16
| Facility | | $284.76 | $388.00 | $571.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.00 / $606.00 / $1,107.11
| Professional | | $407.00 | $606.00 | $1,107.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,744.80 / $15,744.80 / $15,744.80
| Facility | | $15,744.80 | $15,744.80 | $15,744.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.70 / $424.60 / $642.79
| Professional | | $353.70 | $424.60 | $642.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.00 / $1,208.00 / $9,324.00
| Facility | | $773.00 | $1,208.00 | $9,324.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.16 / $342.81 / $769.45
| Professional | | $255.16 | $342.81 | $769.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,633.86 / $16,547.20 / $26,542.00
| Facility | | $1,633.86 | $16,547.20 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,483.85 / $2,709.17 / $2,709.17
| Professional | | $2,483.85 | $2,709.17 | $2,709.17 |