- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $732.00 / $2,221.00 / $7,316.00
| Facility | | $732.00 | $2,221.00 | $7,316.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.57 / $827.47 / $1,219.56
| Professional | | $758.57 | $827.47 | $1,219.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,309.01 / $4,164.67 / $7,936.45
| Facility | | $2,309.01 | $4,164.67 | $7,936.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $774.95 / $987.64 / $1,125.29
| Professional | | $774.95 | $987.64 | $1,125.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $730.88 / $730.88 / $730.88
| Facility | | $730.88 | $730.88 | $730.88 |
- 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
- $849.76 / $1,123.95 / $1,753.65
| Professional | | $849.76 | $1,123.95 | $1,753.65 |
- 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
- $6,038.32 / $6,254.56 / $7,034.18
| Professional | | $6,038.32 | $6,254.56 | $7,034.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $802.64 / $1,059.16 / $1,855.83
| Facility | | $802.64 | $1,059.16 | $1,855.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,057.15 / $1,244.18 / $1,463.74
| Professional | | $1,057.15 | $1,244.18 | $1,463.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,088.20 / $1,088.20 / $1,088.20
| Professional | | $1,088.20 | $1,088.20 | $1,088.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $802.64 / $1,084.76 / $2,129.73
| Facility | | $802.64 | $1,084.76 | $2,129.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $849.76 / $1,145.57 / $1,782.59
| Professional | | $849.76 | $1,145.57 | $1,782.59 |
- 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
- $693.50 / $953.56 / $1,473.68
| Professional | | $693.50 | $953.56 | $1,473.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $694.03 / $786.81 / $1,098.59
| Professional | | $694.03 | $786.81 | $1,098.59 |