- 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
- $331.88 / $464.59 / $685.19
| Professional | | $331.88 | $464.59 | $685.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,711.85 / $3,038.26 / $5,844.30
| Facility | | $1,711.85 | $3,038.26 | $5,844.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.81 / $448.04 / $648.72
| Professional | | $355.81 | $448.04 | $648.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $327.79 / $327.79 / $450.32
| Facility | | $327.79 | $327.79 | $450.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,263.04 / $1,263.04 / $1,304.32
| Facility | | $1,263.04 | $1,263.04 | $1,304.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.53 / $503.45 / $745.33
| Professional | | $376.53 | $503.45 | $745.33 |
- 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
- $3,680.00 / $3,680.00 / $3,680.00
| Professional | | $3,680.00 | $3,680.00 | $3,680.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $381.52 / $497.81 / $847.10
| Facility | | $381.52 | $497.81 | $847.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.16 / $564.77 / $718.71
| Professional | | $414.16 | $564.77 | $718.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.96 / $418.96 / $511.30
| Professional | | $332.96 | $418.96 | $511.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $381.52 / $501.59 / $923.33
| Facility | | $381.52 | $501.59 | $923.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.72 / $520.07 / $777.11
| Professional | | $384.72 | $520.07 | $777.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,120.00 / $3,264.00 / $7,600.00
| Facility | | $1,120.00 | $3,264.00 | $7,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.76 / $449.32 / $664.35
| Professional | | $337.76 | $449.32 | $664.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.82 / $408.52 / $573.36
| Professional | | $360.82 | $408.52 | $573.36 |