- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.91 / $2,128.00 / $6,762.00
| Facility | | $443.91 | $2,128.00 | $6,762.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.52 / $410.39 / $562.48
| Professional | | $331.52 | $410.39 | $562.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,405.51 / $12,101.90 / $24,203.79
| Facility | | $5,405.51 | $12,101.90 | $24,203.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.45 / $372.80 / $417.12
| Professional | | $308.45 | $372.80 | $417.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $299.31 / $299.31 / $299.31
| Facility | | $299.31 | $299.31 | $299.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,860.97 / $6,860.97 / $6,860.97
| Facility | | $6,860.97 | $6,860.97 | $6,860.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.76 / $501.74 / $857.70
| Professional | | $369.76 | $501.74 | $857.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,112.00 / $12,000.00 / $12,000.00
| Facility | | $3,112.00 | $12,000.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,488.48 / $3,920.07 / $6,109.63
| Professional | | $2,488.48 | $3,920.07 | $6,109.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $361.16 / $500.05 / $1,044.26
| Facility | | $361.16 | $500.05 | $1,044.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.02 / $547.05 / $739.44
| Professional | | $431.02 | $547.05 | $739.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,207.20 / $1,207.20 / $1,207.20
| Professional | | $1,207.20 | $1,207.20 | $1,207.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $361.71 / $515.84 / $1,119.09
| Facility | | $361.71 | $515.84 | $1,119.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.58 / $534.61 / $896.75
| Professional | | $373.58 | $534.61 | $896.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.00 / $3,314.00 / $7,600.00
| Facility | | $1,154.00 | $3,314.00 | $7,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.77 / $480.47 / $741.13
| Professional | | $348.77 | $480.47 | $741.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.61 / $399.68 / $555.08
| Professional | | $350.61 | $399.68 | $555.08 |