- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $727.00 / $3,352.00 / $11,453.00
| Facility | | $727.00 | $3,352.00 | $11,453.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.52 / $407.44 / $666.61
| Professional | | $347.52 | $407.44 | $666.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,530.22 / $2,733.77 / $5,797.80
| Facility | | $1,530.22 | $2,733.77 | $5,797.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.34 / $461.01 / $646.64
| Professional | | $372.34 | $461.01 | $646.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $380.12 / $384.89
| Facility | | $80.00 | $380.12 | $384.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.98 / $464.98 / $464.98
| Facility | | $464.98 | $464.98 | $464.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.44 / $537.95 / $805.72
| Professional | | $407.44 | $537.95 | $805.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,301.60 / $11,500.00 / $26,542.00
| Facility | | $2,301.60 | $11,500.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,232.86 / $3,232.86 / $3,532.28
| Professional | | $3,232.86 | $3,232.86 | $3,532.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.43 / $456.32 / $748.55
| Facility | | $371.43 | $456.32 | $748.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $505.41 / $606.50 / $752.05
| Professional | | $505.41 | $606.50 | $752.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.40 / $449.70 / $923.96
| Professional | | $398.40 | $449.70 | $923.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.48 / $462.16 / $798.25
| Facility | | $371.48 | $462.16 | $798.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.88 / $551.57 / $832.33
| Professional | | $412.88 | $551.57 | $832.33 |
- 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
- $315.70 / $418.64 / $658.22
| Professional | | $315.70 | $418.64 | $658.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.08 / $391.04 / $544.62
| Professional | | $345.08 | $391.04 | $544.62 |