- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.00 / $2,673.00 / $7,495.00
| Facility | | $657.00 | $2,673.00 | $7,495.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.01 / $482.81 / $784.86
| Professional | | $428.01 | $482.81 | $784.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,646.41 / $3,501.52 / $6,376.95
| Facility | | $1,646.41 | $3,501.52 | $6,376.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.66 / $578.16 / $805.52
| Professional | | $453.66 | $578.16 | $805.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.05 / $477.05 / $477.05
| Facility | | $477.05 | $477.05 | $477.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,725.26 / $1,725.26 / $1,725.26
| Facility | | $1,725.26 | $1,725.26 | $1,725.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.46 / $647.79 / $969.65
| Professional | | $504.46 | $647.79 | $969.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,817.20 / $16,394.00 / $16,394.00
| Facility | | $6,817.20 | $16,394.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.88 / $3,621.52 / $4,316.63
| Professional | | $3,548.88 | $3,621.52 | $4,316.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.41 / $591.83 / $1,069.65
| Facility | | $457.41 | $591.83 | $1,069.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $635.79 / $748.29 / $880.34
| Professional | | $635.79 | $748.29 | $880.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $608.90 / $608.90 / $608.90
| Professional | | $608.90 | $608.90 | $608.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $459.81 / $609.51 / $1,149.51
| Facility | | $459.81 | $609.51 | $1,149.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $495.09 / $651.01 / $1,026.91
| Professional | | $495.09 | $651.01 | $1,026.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.00 / $3,314.00 / $7,600.00
| Facility | | $1,154.00 | $3,314.00 | $7,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.46 / $535.45 / $856.49
| Professional | | $382.46 | $535.45 | $856.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.42 / $473.46 / $656.34
| Professional | | $417.42 | $473.46 | $656.34 |