- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $661.00 / $2,630.00 / $7,542.00
| Facility | | $661.00 | $2,630.00 | $7,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.70 / $647.91 / $1,095.14
| Professional | | $567.70 | $647.91 | $1,095.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,127.55 / $9,032.74 / $17,826.21
| Facility | | $4,127.55 | $9,032.74 | $17,826.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.66 / $747.64 / $1,018.80
| Professional | | $590.66 | $747.64 | $1,018.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $584.59 / $593.57
| Facility | | $80.00 | $584.59 | $593.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $726.86 / $726.86 / $726.86
| Facility | | $726.86 | $726.86 | $726.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $629.60 / $845.29 / $1,301.79
| Professional | | $629.60 | $845.29 | $1,301.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,400.19 / $16,394.00 / $19,913.50
| Facility | | $2,400.19 | $16,394.00 | $19,913.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,637.04 / $4,729.04 / $5,525.63
| Professional | | $4,637.04 | $4,729.04 | $5,525.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $617.12 / $795.35 / $1,220.02
| Facility | | $617.12 | $795.35 | $1,220.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $790.06 / $948.08 / $1,175.60
| Professional | | $790.06 | $948.08 | $1,175.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $640.61 / $1,049.85 / $2,316.91
| Professional | | $640.61 | $1,049.85 | $2,316.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $617.12 / $814.02 / $1,277.89
| Facility | | $617.12 | $814.02 | $1,277.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $646.58 / $875.32 / $1,328.53
| Professional | | $646.58 | $875.32 | $1,328.53 |
- 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
- $503.76 / $683.47 / $1,070.49
| Professional | | $503.76 | $683.47 | $1,070.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $539.44 / $611.80 / $850.85
| Professional | | $539.44 | $611.80 | $850.85 |