- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $3,019.95 / $9,120.11
| Facility | | $977.24 | $3,019.95 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $831.76 / $2,238.72
| Professional | | $660.69 | $831.76 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $7,762.47 / $13,803.84
| Facility | | $4,073.80 | $7,762.47 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $741.31 / $1,778.28
| Professional | | $575.44 | $741.31 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $10,964.78
| Facility | | $1,000.00 | $1,000.00 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Professional | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,202.26 / $50,118.72
| Facility | | $34.67 | $1,202.26 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,202.26 / $3,235.94
| Professional | | $691.83 | $1,202.26 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,230.27 / $2,398.83
| Facility | | $724.44 | $1,230.27 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $870.96 / $1,258.93
| Professional | | $645.65 | $870.96 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $1,023.29 / $1,479.11
| Professional | | $562.34 | $1,023.29 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $50,118.72 / $75,857.76
| Facility | | $794.33 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $954.99 / $1,548.82
| Professional | | $398.11 | $954.99 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $5,888.44 / $13,803.84
| Facility | | $2,398.83 | $5,888.44 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $794.33 / $2,137.96
| Professional | | $549.54 | $794.33 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $912.01 / $2,570.40
| Facility | | $575.44 | $912.01 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $912.01 / $2,290.87
| Professional | | $575.44 | $912.01 | $2,290.87 |