- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $652.00 / $2,640.00 / $7,542.00
| Facility | | $652.00 | $2,640.00 | $7,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.76 / $372.93 / $531.57
| Professional | | $325.76 | $372.93 | $531.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,198.33 / $3,922.02 / $7,537.78
| Facility | | $2,198.33 | $3,922.02 | $7,537.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.16 / $434.79 / $605.76
| Professional | | $341.16 | $434.79 | $605.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $325.25 / $325.25 / $325.25
| Facility | | $325.25 | $325.25 | $325.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,403.30 / $2,403.30 / $2,403.30
| Facility | | $2,403.30 | $2,403.30 | $2,403.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.85 / $500.83 / $779.53
| Professional | | $372.85 | $500.83 | $779.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,102.00 / $9,496.40 / $11,500.00
| Facility | | $9,102.00 | $9,496.40 | $11,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,793.67 / $2,793.67 / $3,142.20
| Professional | | $2,793.67 | $2,793.67 | $3,142.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $360.94 / $475.64 / $883.50
| Facility | | $360.94 | $475.64 | $883.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.31 / $554.29 / $652.10
| Professional | | $409.31 | $554.29 | $652.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $386.00 / $386.00 / $386.00
| Professional | | $386.00 | $386.00 | $386.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $360.94 / $487.76 / $957.64
| Facility | | $360.94 | $487.76 | $957.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.85 / $513.94 / $834.95
| Professional | | $372.85 | $513.94 | $834.95 |
- 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
- $296.54 / $409.51 / $654.02
| Professional | | $296.54 | $409.51 | $654.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.20 / $352.51 / $487.86
| Professional | | $309.20 | $352.51 | $487.86 |