- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $788.00 / $3,224.00 / $11,453.00
| Facility | | $788.00 | $3,224.00 | $11,453.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.26 / $706.45 / $1,171.98
| Professional | | $605.26 | $706.45 | $1,171.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,408.96 / $4,352.55 / $9,252.58
| Facility | | $2,408.96 | $4,352.55 | $9,252.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $652.84 / $826.34 / $1,114.16
| Professional | | $652.84 | $826.34 | $1,114.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $670.06 / $670.06
| Facility | | $80.00 | $670.06 | $670.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.63 / $789.63 / $789.63
| Facility | | $789.63 | $789.63 | $789.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $664.02 / $870.84 / $1,342.70
| Professional | | $664.02 | $870.84 | $1,342.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,577.60 / $11,500.00 / $26,542.00
| Facility | | $2,577.60 | $11,500.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,008.64 / $5,180.24 / $5,958.83
| Professional | | $5,008.64 | $5,180.24 | $5,958.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $654.74 / $837.08 / $1,299.60
| Facility | | $654.74 | $837.08 | $1,299.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.93 / $1,022.31 / $1,267.66
| Professional | | $851.93 | $1,022.31 | $1,267.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.74 / $1,183.29 / $2,589.71
| Professional | | $681.74 | $1,183.29 | $2,589.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $655.04 / $841.58 / $1,345.31
| Facility | | $655.04 | $841.58 | $1,345.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $672.53 / $901.36 / $1,401.08
| Professional | | $672.53 | $901.36 | $1,401.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,634.00 / $4,345.00 / $10,600.00
| Facility | | $1,634.00 | $4,345.00 | $10,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.98 / $692.12 / $1,073.81
| Professional | | $516.98 | $692.12 | $1,073.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.66 / $654.74 / $920.35
| Professional | | $581.66 | $654.74 | $920.35 |