- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $767.00 / $3,224.00 / $11,453.00
| Facility | | $767.00 | $3,224.00 | $11,453.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.10 / $517.96 / $613.76
| Professional | | $471.10 | $517.96 | $613.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,456.92 / $5,821.21 / $8,577.84
| Facility | | $5,456.92 | $5,821.21 | $8,577.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,536.39 / $1,536.39 / $1,536.39
| Professional | | $1,536.39 | $1,536.39 | $1,536.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Facility | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $608.72 / $608.72 / $608.72
| Facility | | $608.72 | $608.72 | $608.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,536.67 / $2,536.67 / $2,536.67
| Professional | | $2,536.67 | $2,536.67 | $2,536.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,001.40 / $31,450.65 / $31,450.65
| Facility | | $2,001.40 | $31,450.65 | $31,450.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,849.04 / $3,956.80 / $4,612.35
| Professional | | $3,849.04 | $3,956.80 | $4,612.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.91 / $613.76 / $1,075.97
| Facility | | $497.91 | $613.76 | $1,075.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.01 / $4,663.00 / $5,830.00
| Professional | | $510.01 | $4,663.00 | $5,830.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $465.05 / $613.76 / $1,075.97
| Facility | | $465.05 | $613.76 | $1,075.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.01 / $694.00 / $2,536.67
| Professional | | $510.01 | $694.00 | $2,536.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.00 / $3,326.00 / $7,600.00
| Facility | | $1,154.00 | $3,326.00 | $7,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.44 / $573.98 / $904.62
| Professional | | $417.44 | $573.98 | $904.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $625.10 / $625.10 / $843.89
| Professional | | $625.10 | $625.10 | $843.89 |