- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $662.00 / $2,673.00 / $7,542.00
| Facility | | $662.00 | $2,673.00 | $7,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.78 / $568.40 / $949.35
| Professional | | $496.78 | $568.40 | $949.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $706.87 / $1,219.08 / $4,353.00
| Facility | | $706.87 | $1,219.08 | $4,353.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.66 / $667.38 / $909.43
| Professional | | $523.66 | $667.38 | $909.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $500.77 / $504.93
| Facility | | $80.00 | $500.77 | $504.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $658.46 / $658.46 / $658.46
| Facility | | $658.46 | $658.46 | $658.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $578.46 / $784.51 / $1,200.39
| Professional | | $578.46 | $784.51 | $1,200.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $5,246.20
| Facility | | $55.00 | $55.00 | $5,246.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,579.65 / $6,579.65 / $6,579.65
| Professional | | $6,579.65 | $6,579.65 | $6,579.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $533.84 / $662.33 / $1,255.19
| Facility | | $533.84 | $662.33 | $1,255.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $708.79 / $850.55 / $1,054.68
| Professional | | $708.79 | $850.55 | $1,054.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $568.50 / $940.61 / $1,294.27
| Professional | | $568.50 | $940.61 | $1,294.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $533.84 / $668.11 / $1,255.19
| Facility | | $533.84 | $668.11 | $1,255.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.22 / $809.42 / $1,209.83
| Professional | | $585.22 | $809.42 | $1,209.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.00 / $3,326.00 / $7,600.00
| Facility | | $1,154.00 | $3,326.00 | $7,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.44 / $602.34 / $960.70
| Professional | | $451.44 | $602.34 | $960.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.94 / $551.94 / $766.96
| Professional | | $483.94 | $551.94 | $766.96 |