- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $639.75 / $2,244.00 / $7,513.00
| Facility | | $639.75 | $2,244.00 | $7,513.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.41 / $686.77 / $1,138.61
| Professional | | $588.41 | $686.77 | $1,138.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,673.55 / $4,215.67 / $7,254.24
| Facility | | $1,673.55 | $4,215.67 | $7,254.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $634.07 / $802.58 / $1,082.11
| Professional | | $634.07 | $802.58 | $1,082.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $653.04 / $653.04
| Facility | | $80.00 | $653.04 | $653.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $767.64 / $767.64 / $767.64
| Facility | | $767.64 | $767.64 | $767.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.33 / $842.82 / $1,294.30
| Professional | | $638.33 | $842.82 | $1,294.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,505.12 / $11,500.00 / $12,000.00
| Facility | | $2,505.12 | $11,500.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,866.47 / $5,035.04 / $5,794.58
| Professional | | $4,866.47 | $5,035.04 | $5,794.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $635.50 / $813.93 / $1,273.53
| Facility | | $635.50 | $813.93 | $1,273.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $828.08 / $993.69 / $1,232.18
| Professional | | $828.08 | $993.69 | $1,232.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $664.55 / $1,152.58 / $2,522.52
| Professional | | $664.55 | $1,152.58 | $2,522.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $635.50 / $818.66 / $1,285.76
| Facility | | $635.50 | $818.66 | $1,285.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.50 / $872.69 / $1,358.08
| Professional | | $648.50 | $872.69 | $1,358.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $600.00 / $2,064.00 / $4,509.00
| Facility | | $600.00 | $2,064.00 | $4,509.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.48 / $669.41 / $1,091.09
| Professional | | $500.48 | $669.41 | $1,091.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.39 / $636.10 / $894.63
| Professional | | $565.39 | $636.10 | $894.63 |