- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.96 / $3,100.00 / $10,170.00
| Facility | | $587.96 | $3,100.00 | $10,170.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.32 / $600.92 / $1,078.53
| Professional | | $467.32 | $600.92 | $1,078.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,283.00 / $4,922.00 / $11,208.00
| Facility | | $3,283.00 | $4,922.00 | $11,208.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.49 / $556.95 / $1,235.68
| Professional | | $448.49 | $556.95 | $1,235.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $808.00 / $808.00 / $37,499.62
| Facility | | $808.00 | $808.00 | $37,499.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $808.00 / $808.00 / $808.00
| Professional | | $808.00 | $808.00 | $808.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.60 / $650.60 / $7,227.90
| Facility | | $650.60 | $650.60 | $7,227.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.03 / $812.15 / $2,103.90
| Professional | | $476.03 | $812.15 | $2,103.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.00 / $563.50 / $1,552.82
| Facility | | $332.00 | $563.50 | $1,552.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $621.13 / $798.59 / $1,193.94
| Professional | | $621.13 | $798.59 | $1,193.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $535.80 / $535.80 / $535.80
| Facility | | $535.80 | $535.80 | $535.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.47 / $681.35 / $1,057.45
| Professional | | $384.47 | $681.35 | $1,057.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $650.60 / $7,227.90
| Facility | | $597.00 | $650.60 | $7,227.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.75 / $785.92 / $1,869.67
| Professional | | $548.75 | $785.92 | $1,869.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $996.00 / $4,194.00 / $9,020.04
| Facility | | $996.00 | $4,194.00 | $9,020.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.27 / $659.47 / $1,603.54
| Professional | | $467.27 | $659.47 | $1,603.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $681.35 / $681.35 / $1,777.66
| Facility | | $681.35 | $681.35 | $1,777.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.47 / $764.16 / $1,440.26
| Professional | | $384.47 | $764.16 | $1,440.26 |