- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $527.40 / $2,124.00 / $6,762.00
| Facility | | $527.40 | $2,124.00 | $6,762.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.22 / $549.15 / $788.90
| Professional | | $500.22 | $549.15 | $788.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,278.78 / $4,138.47 / $7,916.62
| Facility | | $2,278.78 | $4,138.47 | $7,916.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.67 / $600.72 / $900.51
| Professional | | $451.67 | $600.72 | $900.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $482.26 / $482.26 / $482.26
| Facility | | $482.26 | $482.26 | $482.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,001.65 / $2,001.65 / $2,001.65
| Facility | | $2,001.65 | $2,001.65 | $2,001.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.52 / $724.41 / $1,111.17
| Professional | | $545.52 | $724.41 | $1,111.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,909.30 / $12,000.00 / $12,000.00
| Facility | | $7,909.30 | $12,000.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,641.26 / $4,641.26 / $4,641.26
| Professional | | $4,641.26 | $4,641.26 | $4,641.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $513.14 / $689.51 / $1,368.34
| Facility | | $513.14 | $689.51 | $1,368.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $689.62 / $811.63 / $954.86
| Professional | | $689.62 | $811.63 | $954.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $646.70 / $646.70 / $646.70
| Professional | | $646.70 | $646.70 | $646.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $513.14 / $694.75 / $1,492.80
| Facility | | $513.14 | $694.75 | $1,492.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $552.02 / $736.22 / $1,177.18
| Professional | | $552.02 | $736.22 | $1,177.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,093.00 / $6,000.00 / $13,134.00
| Facility | | $2,093.00 | $6,000.00 | $13,134.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $445.49 / $612.54 / $1,015.16
| Professional | | $445.49 | $612.54 | $1,015.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.75 / $511.13 / $717.44
| Professional | | $452.75 | $511.13 | $717.44 |