- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.37 / $2,514.00 / $7,495.00
| Facility | | $672.37 | $2,514.00 | $7,495.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $637.29 / $782.79 / $1,158.52
| Professional | | $637.29 | $782.79 | $1,158.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,232.96 / $4,495.71 / $8,663.91
| Facility | | $2,232.96 | $4,495.71 | $8,663.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $697.47 / $882.83 / $1,250.04
| Professional | | $697.47 | $882.83 | $1,250.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $658.76 / $658.76 / $876.09
| Facility | | $658.76 | $658.76 | $876.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $756.36 / $960.94 / $1,463.89
| Professional | | $756.36 | $960.94 | $1,463.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,209.26 / $16,394.00 / $16,394.00
| Facility | | $5,209.26 | $16,394.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,508.64 / $6,307.92 / $7,336.50
| Professional | | $5,508.64 | $6,307.92 | $7,336.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.22 / $893.11 / $1,270.34
| Facility | | $710.22 | $893.11 | $1,270.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $868.50 / $1,221.68 / $1,578.71
| Professional | | $868.50 | $1,221.68 | $1,578.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $718.76 / $881.76 / $1,151.45
| Professional | | $718.76 | $881.76 | $1,151.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $697.99 / $898.45 / $1,297.59
| Facility | | $697.99 | $898.45 | $1,297.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.60 / $1,012.18 / $1,609.86
| Professional | | $776.60 | $1,012.18 | $1,609.86 |
- 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
- $676.95 / $902.60 / $1,308.77
| Professional | | $676.95 | $902.60 | $1,308.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.40 / $821.16 / $1,146.99
| Professional | | $724.40 | $821.16 | $1,146.99 |