- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $918.00 / $2,747.00 / $8,017.00
| Facility | | $918.00 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.81 / $449.00 / $746.65
| Professional | | $401.81 | $449.00 | $746.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.35 / $6,182.00 / $17,094.48
| Facility | | $5,058.35 | $6,182.00 | $17,094.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.30 / $473.52 / $473.52
| Professional | | $456.30 | $473.52 | $473.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $518.54 / $518.54 / $518.54
| Facility | | $518.54 | $518.54 | $518.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.82 / $533.30 / $904.67
| Professional | | $402.82 | $533.30 | $904.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $542.40 / $728.95 / $936.87
| Professional | | $542.40 | $728.95 | $936.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,164.13 / $7,164.13 / $7,164.13
| Facility | | $7,164.13 | $7,164.13 | $7,164.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.00 / $3,077.00 / $8,017.00
| Facility | | $954.00 | $3,077.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.95 / $495.19 / $2,333.63
| Professional | | $403.95 | $495.19 | $2,333.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.80 / $492.80 / $929.60
| Professional | | $492.80 | $492.80 | $929.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $518.54 / $518.54 / $518.54
| Facility | | $518.54 | $518.54 | $518.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.46 / $550.54 / $904.67
| Professional | | $403.46 | $550.54 | $904.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $415.79 / $441.22 / $441.22
| Facility | | $415.79 | $441.22 | $441.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.79 / $441.22 / $470.28
| Professional | | $415.79 | $441.22 | $470.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.00 / $2,391.00 / $4,789.00
| Facility | | $912.00 | $2,391.00 | $4,789.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.14 / $533.30 / $866.14
| Professional | | $397.14 | $533.30 | $866.14 |