- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,949.84 / $18,620.87
| Facility | | $851.14 | $1,949.84 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $645.65 / $1,513.56
| Professional | | $436.52 | $645.65 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $2,454.71
| Facility | | $912.01 | $912.01 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $812.83 / $1,621.81
| Professional | | $501.19 | $812.83 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,071.52 / $2,290.87
| Facility | | $588.84 | $1,071.52 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,754.40 / $9,332.54 / $16,595.87
| Facility | 50 | $5,754.40 | $9,332.54 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,047.13 / $1,659.59
| Professional | | $588.84 | $1,047.13 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $389.05
| Professional | | $32.36 | $33.11 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,122.02 / $1,230.27
| Facility | | $812.83 | $1,122.02 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $831.76
| Facility | | $812.83 | $812.83 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,071.52 / $1,513.56
| Professional | | $602.56 | $1,071.52 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $6,606.93 / $12,589.25
| Facility | | $4,365.16 | $6,606.93 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,606.93 / $10,000.00 / $19,054.61
| Facility | 50 | $6,606.93 | $10,000.00 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,096.48 / $1,548.82
| Professional | | $776.25 | $1,096.48 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $7,413.10 / $13,489.63
| Facility | | $1,380.38 | $7,413.10 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $794.33 / $1,513.56
| Professional | | $537.03 | $794.33 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $724.44 / $1,202.26
| Professional | | $81.28 | $724.44 | $1,202.26 |