- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $886.00 / $1,764.31 / $3,693.00
| Facility | | $886.00 | $1,764.31 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.32 / $803.99 / $1,999.82
| Professional | | $524.32 | $803.99 | $1,999.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $3,315.28 / $8,498.00
| Facility | | $1,089.00 | $3,315.28 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.29 / $1,172.23 / $4,557.35
| Professional | | $581.29 | $1,172.23 | $4,557.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $743.44 / $966.47 / $1,705.45
| Facility | | $743.44 | $966.47 | $1,705.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,046.53 / $1,463.03 / $1,998.18
| Professional | | $1,046.53 | $1,463.03 | $1,998.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $701.51 / $1,133.17 / $2,361.41
| Professional | | $701.51 | $1,133.17 | $2,361.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $626.89 / $1,355.58 / $6,679.00
| Facility | | $626.89 | $1,355.58 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $848.95 / $1,067.57 / $1,473.67
| Professional | | $848.95 | $1,067.57 | $1,473.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $774.14 / $1,595.27 / $2,348.39
| Professional | | $774.14 | $1,595.27 | $2,348.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $383.34 / $3,103.34 / $6,059.95
| Facility | | $383.34 | $3,103.34 | $6,059.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $897.48 / $1,165.99 / $1,231.49
| Professional | | $897.48 | $1,165.99 | $1,231.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $4,308.12 / $16,394.00
| Facility | | $1,640.00 | $4,308.12 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $798.85 / $1,432.73 / $5,540.32
| Professional | | $798.85 | $1,432.73 | $5,540.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $603.67 / $1,045.73 / $2,058.19
| Professional | | $603.67 | $1,045.73 | $2,058.19 |