- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,981.07 / $8,317.64
| Facility | | $1,047.13 | $3,981.07 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $489.78 / $977.24
| Professional | | $426.58 | $489.78 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $7,585.78 / $57,543.99
| Facility | | $6,456.54 | $7,585.78 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $588.84 / $891.25
| Professional | | $467.74 | $588.84 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $645.65 / $1,023.29
| Professional | | $467.74 | $645.65 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $724.44 / $794.33
| Professional | | $562.34 | $724.44 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $630.96 / $851.14
| Professional | | $489.78 | $630.96 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $8,912.51 / $8,912.51
| Facility | | $8,912.51 | $8,912.51 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,818.38 / $8,317.64
| Facility | | $954.99 | $2,818.38 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $575.44 / $1,584.89
| Professional | | $426.58 | $575.44 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $977.24 / $977.24
| Facility | | $977.24 | $977.24 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $831.76 / $977.24
| Professional | | $5.01 | $831.76 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $524.81
| Facility | | $512.86 | $512.86 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $524.81 / $537.03
| Professional | | $380.19 | $524.81 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,981.07 / $10,000.00
| Facility | | $2,137.96 | $3,981.07 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $575.44 / $977.24
| Professional | | $416.87 | $575.44 | $977.24 |