- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $668.37 / $2,630.00 / $7,495.00
| Facility | | $668.37 | $2,630.00 | $7,495.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.48 / $590.17 / $825.75
| Professional | | $530.48 | $590.17 | $825.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,258.35 / $6,347.43 / $12,610.23
| Facility | | $3,258.35 | $6,347.43 | $12,610.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $509.10 / $644.40 / $897.79
| Professional | | $509.10 | $644.40 | $897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502.63 / $502.63 / $502.63
| Facility | | $502.63 | $502.63 | $502.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,619.61 / $3,619.61 / $3,619.61
| Facility | | $3,619.61 | $3,619.61 | $3,619.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.78 / $750.22 / $1,138.52
| Professional | | $575.78 | $750.22 | $1,138.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,500.00 / $16,394.00 / $16,394.00
| Facility | | $11,500.00 | $16,394.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,091.04 / $4,183.20 / $4,682.10
| Professional | | $4,091.04 | $4,183.20 | $4,682.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $546.54 / $699.83 / $1,231.60
| Facility | | $546.54 | $699.83 | $1,231.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $710.23 / $835.88 / $983.39
| Professional | | $710.23 | $835.88 | $983.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $797.20 / $797.20 / $797.20
| Professional | | $797.20 | $797.20 | $797.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $546.54 / $709.36 / $1,419.30
| Facility | | $546.54 | $709.36 | $1,419.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.78 / $759.01 / $1,174.63
| Professional | | $575.78 | $759.01 | $1,174.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,634.00 / $4,345.00 / $10,600.00
| Facility | | $1,634.00 | $4,345.00 | $10,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.75 / $617.03 / $986.54
| Professional | | $448.75 | $617.03 | $986.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.28 / $532.74 / $737.84
| Professional | | $466.28 | $532.74 | $737.84 |