- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $4,265.80 / $10,964.78
| Facility | | $549.54 | $4,265.80 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $524.81 / $1,621.81
| Professional | | $436.52 | $524.81 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,818.38 / $7,943.28
| Facility | | $1,000.00 | $2,818.38 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $537.03 / $891.25
| Professional | | $416.87 | $537.03 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $489.78 / $489.78
| Facility | | $489.78 | $489.78 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $660.69 / $1,096.48
| Professional | | $467.74 | $660.69 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $660.69 / $1,023.29
| Professional | | $446.68 | $660.69 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $2,511.89
| Facility | | $100.00 | $100.00 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $616.60 / $1,096.48
| Professional | | $457.09 | $616.60 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,570.40 / $5,248.07
| Facility | | $1,698.24 | $2,570.40 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $549.54 / $912.01
| Professional | | $407.38 | $549.54 | $912.01 |