- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $661.00 / $2,500.00 / $7,495.00
| Facility | | $661.00 | $2,500.00 | $7,495.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $557.19 / $676.44 / $1,020.77
| Professional | | $557.19 | $676.44 | $1,020.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.94 / $2,131.96 / $4,144.00
| Facility | | $1,146.94 | $2,131.96 | $4,144.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.70 / $697.80 / $1,096.70
| Professional | | $541.70 | $697.80 | $1,096.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $543.09 / $543.09
| Facility | | $80.00 | $543.09 | $543.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $959.91 / $959.91 / $959.91
| Facility | | $959.91 | $959.91 | $959.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.72 / $813.15 / $1,297.32
| Professional | | $582.72 | $813.15 | $1,297.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,055.28 / $11,500.00 / $16,394.00
| Facility | | $4,055.28 | $11,500.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,268.32 / $5,117.68 / $5,961.68
| Professional | | $4,268.32 | $5,117.68 | $5,961.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $503.41 / $722.75 / $1,187.91
| Facility | | $503.41 | $722.75 | $1,187.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.13 / $945.75 / $1,238.99
| Professional | | $745.13 | $945.75 | $1,238.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.20 / $414.20 / $414.20
| Professional | | $414.20 | $414.20 | $414.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.80 / $726.37 / $1,259.02
| Facility | | $501.80 | $726.37 | $1,259.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $611.86 / $877.20 / $1,364.48
| Professional | | $611.86 | $877.20 | $1,364.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $774.00 / $2,478.00 / $4,739.00
| Facility | | $774.00 | $2,478.00 | $4,739.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.37 / $732.49 / $1,140.97
| Professional | | $549.37 | $732.49 | $1,140.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $587.47 / $658.56 / $933.90
| Professional | | $587.47 | $658.56 | $933.90 |