- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $569.00 / $2,550.00 / $7,495.00
| Facility | | $569.00 | $2,550.00 | $7,495.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.65 / $475.41 / $705.64
| Professional | | $336.65 | $475.41 | $705.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,713.91 / $3,032.79 / $6,389.08
| Facility | | $1,713.91 | $3,032.79 | $6,389.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $327.79 / $327.79 / $463.32
| Facility | | $327.79 | $327.79 | $463.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,494.86 / $1,494.86 / $1,543.72
| Facility | | $1,494.86 | $1,494.86 | $1,543.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.33 / $513.97 / $783.17
| Professional | | $384.33 | $513.97 | $783.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,667.72 / $16,394.00 / $16,394.00
| Facility | | $2,667.72 | $16,394.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,835.68 / $3,267.52 / $3,726.23
| Professional | | $2,835.68 | $3,267.52 | $3,726.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $383.10 / $503.15 / $777.24
| Facility | | $383.10 | $503.15 | $777.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.16 / $565.58 / $739.60
| Professional | | $414.16 | $565.58 | $739.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.96 / $420.13 / $579.40
| Professional | | $332.96 | $420.13 | $579.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $383.10 / $507.57 / $810.00
| Facility | | $383.10 | $507.57 | $810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $386.20 / $526.78 / $808.08
| Professional | | $386.20 | $526.78 | $808.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $2,100.00 / $4,562.00
| Facility | | $597.00 | $2,100.00 | $4,562.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.60 / $462.31 / $679.61
| Professional | | $347.60 | $462.31 | $679.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.31 / $420.13 / $590.07
| Professional | | $371.31 | $420.13 | $590.07 |