- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $872.00 / $3,617.00 / $12,281.00
| Facility | | $872.00 | $3,617.00 | $12,281.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.53 / $607.69 / $925.85
| Professional | | $524.53 | $607.69 | $925.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,017.59 / $3,627.52 / $7,337.28
| Facility | | $2,017.59 | $3,627.52 | $7,337.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.27 / $687.64 / $937.04
| Professional | | $543.27 | $687.64 | $937.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.99 / $3,611.17 / $3,611.17
| Facility | | $570.99 | $3,611.17 | $3,611.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,512.62 / $2,006.70 / $3,125.00
| Facility | | $1,512.62 | $2,006.70 | $3,125.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.01 / $746.75 / $1,150.36
| Professional | | $538.01 | $746.75 | $1,150.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,929.30 / $11,500.00 / $26,542.00
| Facility | | $7,929.30 | $11,500.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,206.72 / $4,281.28 / $5,115.38
| Professional | | $4,206.72 | $4,281.28 | $5,115.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.48 / $647.89 / $1,190.92
| Facility | | $537.48 | $647.89 | $1,190.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $666.60 / $886.86 / $1,078.15
| Professional | | $666.60 | $886.86 | $1,078.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.36 / $722.05 / $1,171.83
| Professional | | $579.36 | $722.05 | $1,171.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $539.45 / $661.87 / $1,252.07
| Facility | | $539.45 | $661.87 | $1,252.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $556.16 / $774.07 / $1,419.54
| Professional | | $556.16 | $774.07 | $1,419.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,190.00 / $3,226.00 / $7,600.00
| Facility | | $1,190.00 | $3,226.00 | $7,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.30 / $601.67 / $936.06
| Professional | | $440.30 | $601.67 | $936.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.71 / $575.54 / $777.92
| Professional | | $494.71 | $575.54 | $777.92 |