- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,475.00 / $6,220.40 / $12,387.60
| Facility | | $2,475.00 | $6,220.40 | $12,387.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.58 / $414.13 / $1,200.00
| Professional | | $270.58 | $414.13 | $1,200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.26 / $473.27 / $544.27
| Professional | | $239.26 | $473.27 | $544.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,074.79 / $8,806.74 / $15,455.25
| Facility | | $6,074.79 | $8,806.74 | $15,455.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.93 / $446.45 / $595.28
| Professional | | $261.93 | $446.45 | $595.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.55 / $647.59 / $897.88
| Professional | | $393.55 | $647.59 | $897.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.58 / $487.06 / $5,132.00
| Facility | | $270.58 | $487.06 | $5,132.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.75 / $614.08 / $2,630.26
| Professional | | $407.75 | $614.08 | $2,630.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.01 / $726.57 / $5,251.23
| Facility | | $532.01 | $726.57 | $5,251.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.00 / $647.01 / $868.18
| Professional | | $448.00 | $647.01 | $868.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $441.60 / $794.60
| Professional | | $5.00 | $441.60 | $794.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.75 / $614.08 / $761.12
| Professional | | $407.75 | $614.08 | $761.12 |