- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $652.00 / $2,759.00 / $7,542.00
| Facility | | $652.00 | $2,759.00 | $7,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.83 / $429.49 / $746.25
| Professional | | $369.83 | $429.49 | $746.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,314.73 / $2,182.17 / $4,503.00
| Facility | | $1,314.73 | $2,182.17 | $4,503.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.18 / $476.91 / $668.93
| Professional | | $385.18 | $476.91 | $668.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $286.33 / $286.33 / $396.41
| Facility | | $286.33 | $286.33 | $396.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $485.41 / $485.41 / $485.41
| Facility | | $485.41 | $485.41 | $485.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.52 / $555.10 / $862.51
| Professional | | $422.52 | $555.10 | $862.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,583.36 / $11,500.00 / $16,394.00
| Facility | | $1,583.36 | $11,500.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,560.42 / $3,647.33 / $3,677.92
| Professional | | $3,560.42 | $3,647.33 | $3,677.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $413.78 / $564.97 / $877.57
| Facility | | $413.78 | $564.97 | $877.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.59 / $625.91 / $776.12
| Professional | | $521.59 | $625.91 | $776.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $617.10 / $617.10 / $617.10
| Professional | | $617.10 | $617.10 | $617.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $413.78 / $566.79 / $905.93
| Facility | | $413.78 | $566.79 | $905.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.20 / $596.91 / $880.66
| Professional | | $427.20 | $596.91 | $880.66 |
- 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
- $333.72 / $449.55 / $725.55
| Professional | | $333.72 | $449.55 | $725.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.13 / $403.38 / $562.05
| Professional | | $356.13 | $403.38 | $562.05 |