- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $647.90 / $3,570.00 / $10,893.00
| Facility | | $647.90 | $3,570.00 | $10,893.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.08 / $523.30 / $748.26
| Professional | | $449.08 | $523.30 | $748.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,180.09 / $3,703.80 / $7,946.77
| Facility | | $2,180.09 | $3,703.80 | $7,946.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.93 / $591.02 / $823.43
| Professional | | $466.93 | $591.02 | $823.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.72 / $497.72 / $506.29
| Facility | | $497.72 | $497.72 | $506.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,512.62 / $2,006.70 / $6,644.00
| Facility | | $1,512.62 | $2,006.70 | $6,644.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.75 / $647.12 / $997.83
| Professional | | $482.75 | $647.12 | $997.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $7,929.30
| Facility | | $55.00 | $55.00 | $7,929.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,627.28 / $3,688.64 / $4,405.88
| Professional | | $3,627.28 | $3,688.64 | $4,405.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $481.85 / $579.84 / $1,082.85
| Facility | | $481.85 | $579.84 | $1,082.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $574.34 / $764.13 / $928.94
| Professional | | $574.34 | $764.13 | $928.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $601.50 / $1,312.30
| Professional | | $5.00 | $601.50 | $1,312.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $482.75 / $603.45 / $1,110.52
| Facility | | $482.75 | $603.45 | $1,110.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.09 / $676.53 / $1,252.07
| Professional | | $496.09 | $676.53 | $1,252.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,691.00 / $4,964.00 / $10,476.00
| Facility | | $1,691.00 | $4,964.00 | $10,476.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.37 / $541.15 / $850.28
| Professional | | $396.37 | $541.15 | $850.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.25 / $496.03 / $670.76
| Professional | | $426.25 | $496.03 | $670.76 |