- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.00 / $5,298.00 / $10,170.00
| Facility | | $1,819.00 | $5,298.00 | $10,170.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.72 / $577.47 / $648.25
| Professional | | $362.72 | $577.47 | $648.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,263.00 / $5,184.00 / $11,809.00
| Facility | | $3,263.00 | $5,184.00 | $11,809.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.45 / $490.84 / $840.71
| Professional | | $416.45 | $490.84 | $840.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,511.50 / $5,511.50 / $16,534.50
| Facility | | $5,511.50 | $5,511.50 | $16,534.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.54 / $570.54 / $7,227.90
| Facility | | $570.54 | $570.54 | $7,227.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.14 / $2,243.57 / $2,243.57
| Professional | | $450.14 | $2,243.57 | $2,243.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.58 / $663.87 / $935.48
| Professional | | $442.58 | $663.87 | $935.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $597.00 / $74,999.25
| Facility | | $555.00 | $597.00 | $74,999.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.14 / $2,243.57 / $2,243.57
| Professional | | $450.14 | $2,243.57 | $2,243.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,264.00 / $5,248.00 / $11,176.00
| Facility | | $2,264.00 | $5,248.00 | $11,176.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.47 / $703.03 / $1,664.87
| Professional | | $511.47 | $703.03 | $1,664.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $482.21 / $482.21 / $482.21
| Facility | | $482.21 | $482.21 | $482.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.21 / $689.09 / $1,011.60
| Professional | | $482.21 | $689.09 | $1,011.60 |