- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,318.26 / $13,182.57
| Facility | | $851.14 | $1,318.26 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $602.56 / $1,380.38
| Professional | | $398.11 | $602.56 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $912.01 / $1,548.82
| Professional | | $512.86 | $912.01 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,047.13 / $1,445.44
| Professional | | $776.25 | $1,047.13 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $794.33 / $1,288.25
| Facility | | $436.52 | $794.33 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $954.99 / $1,380.38
| Professional | | $691.83 | $954.99 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,148.15 / $1,174.90
| Facility | | $812.83 | $1,148.15 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $794.33 / $1,230.27
| Facility | | $436.52 | $794.33 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $954.99 / $1,479.11
| Professional | | $79.43 | $954.99 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $10,232.93 / $12,302.69
| Facility | | $7,762.47 | $10,232.93 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,096.48 / $1,479.11
| Professional | | $776.25 | $1,096.48 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $10,000.00 / $14,125.38
| Facility | | $1,995.26 | $10,000.00 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $954.99 / $1,445.44
| Professional | | $602.56 | $954.99 | $1,445.44 |