- 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
- $544.27 / $799.89 / $979.42
| Professional | | $544.27 | $799.89 | $979.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,046.00 / $7,264.00 / $12,538.00
| Facility | | $4,046.00 | $7,264.00 | $12,538.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $612.19 / $720.22 / $1,225.98
| Professional | | $612.19 | $720.22 | $1,225.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $611.91 / $611.91 / $611.91
| Facility | | $611.91 | $611.91 | $611.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,724.70 / $3,724.70 / $3,724.70
| Professional | | $3,724.70 | $3,724.70 | $3,724.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $856.59 / $1,835.19
| Facility | | $294.00 | $856.59 | $1,835.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $815.64 / $978.77 / $1,518.10
| Professional | | $815.64 | $978.77 | $1,518.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $734.46 / $980.83 / $1,667.18
| Professional | | $734.46 | $980.83 | $1,667.18 |
- 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
- $3,724.70 / $3,724.70 / $3,724.70
| Professional | | $3,724.70 | $3,724.70 | $3,724.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,264.00 / $5,731.00 / $12,509.00
| Facility | | $2,264.00 | $5,731.00 | $12,509.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $706.50 / $935.51 / $1,961.10
| Professional | | $706.50 | $935.51 | $1,961.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $734.71 / $734.71 / $734.71
| Facility | | $734.71 | $734.71 | $734.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $734.71 / $734.71 / $1,667.18
| Professional | | $734.71 | $734.71 | $1,667.18 |