- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,414.00 / $3,478.00 / $9,872.00
| Facility | | $1,414.00 | $3,478.00 | $9,872.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.28 / $368.56 / $581.97
| Professional | | $344.28 | $368.56 | $581.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,171.00 / $11,898.00 / $21,226.00
| Facility | | $7,171.00 | $11,898.00 | $21,226.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $420.56 / $551.84 / $761.16
| Professional | | $420.56 | $551.84 | $761.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.01 / $559.87 / $753.67
| Professional | | $410.01 | $559.87 | $753.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $351.17 / $494.44 / $612.82
| Facility | | $351.17 | $494.44 | $612.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.81 / $564.03 / $725.18
| Professional | | $457.81 | $564.03 | $725.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,146.00 / $13,938.00 / $28,097.00
| Facility | | $11,146.00 | $13,938.00 | $28,097.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.80 / $587.42 / $980.40
| Professional | | $412.80 | $587.42 | $980.40 |