- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $714.00 / $3,511.00 / $12,040.00
| Facility | | $714.00 | $3,511.00 | $12,040.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.02 / $647.32 / $1,014.90
| Professional | | $522.02 | $647.32 | $1,014.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,278.78 / $4,217.06 / $8,686.29
| Facility | | $2,278.78 | $4,217.06 | $8,686.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $493.06 / $637.88 / $1,023.87
| Professional | | $493.06 | $637.88 | $1,023.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $498.97 / $498.97
| Facility | | $80.00 | $498.97 | $498.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $910.23 / $910.23 / $910.23
| Facility | | $910.23 | $910.23 | $910.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.21 / $834.79 / $1,349.06
| Professional | | $584.21 | $834.79 | $1,349.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,791.10 / $11,500.00 / $26,542.00
| Facility | | $3,791.10 | $11,500.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,008.16 / $4,721.60 / $5,455.58
| Professional | | $4,008.16 | $4,721.60 | $5,455.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $556.83 / $736.63 / $1,241.80
| Facility | | $556.83 | $736.63 | $1,241.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $696.77 / $884.37 / $1,138.85
| Professional | | $696.77 | $884.37 | $1,138.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $603.90 / $603.90 / $603.90
| Professional | | $603.90 | $603.90 | $603.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $556.83 / $746.49 / $1,265.76
| Facility | | $556.83 | $746.49 | $1,265.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $595.72 / $886.50 / $1,393.94
| Professional | | $595.72 | $886.50 | $1,393.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.00 / $3,451.00 / $7,600.00
| Facility | | $1,154.00 | $3,451.00 | $7,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.47 / $761.02 / $1,171.33
| Professional | | $553.47 | $761.02 | $1,171.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $539.99 / $608.40 / $857.82
| Professional | | $539.99 | $608.40 | $857.82 |