- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.00 / $2,673.00 / $7,542.00
| Facility | | $624.00 | $2,673.00 | $7,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.81 / $275.00 / $413.65
| Professional | | $251.81 | $275.00 | $413.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,258.35 / $6,347.43 / $12,341.08
| Facility | | $3,258.35 | $6,347.43 | $12,341.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.11 / $294.54 / $410.36
| Professional | | $231.11 | $294.54 | $410.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.36 / $222.36 / $222.36
| Facility | | $222.36 | $222.36 | $222.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,116.43 / $5,116.43 / $5,116.43
| Facility | | $5,116.43 | $5,116.43 | $5,116.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.10 / $352.17 / $550.46
| Professional | | $266.10 | $352.17 | $550.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,500.00 / $16,394.00 / $20,217.09
| Facility | | $11,500.00 | $16,394.00 | $20,217.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,676.43 / $7,906.73 / $7,906.73
| Professional | | $7,676.43 | $7,906.73 | $7,906.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $258.95 / $374.01 / $1,868.49
| Facility | | $258.95 | $374.01 | $1,868.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.52 / $379.59 / $446.58
| Professional | | $322.52 | $379.59 | $446.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.60 / $407.60 / $407.60
| Professional | | $407.60 | $407.60 | $407.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $258.95 / $378.16 / $1,868.49
| Facility | | $258.95 | $378.16 | $1,868.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.64 / $358.70 / $612.75
| Professional | | $271.64 | $358.70 | $612.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,093.00 / $6,002.00 / $13,134.00
| Facility | | $2,093.00 | $6,002.00 | $13,134.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.14 / $310.14 / $817.22
| Professional | | $219.14 | $310.14 | $817.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.75 / $243.44 / $334.61
| Professional | | $211.75 | $243.44 | $334.61 |