- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $717.83 / $3,066.00 / $7,606.34
| Facility | | $717.83 | $3,066.00 | $7,606.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.76 / $829.46 / $1,511.85
| Professional | | $681.76 | $829.46 | $1,511.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,736.00 / $4,444.00 / $15,949.31
| Facility | | $3,736.00 | $4,444.00 | $15,949.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $918.14 / $1,475.33 / $1,674.13
| Professional | | $918.14 | $1,475.33 | $1,674.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $693.95 / $930.50 / $1,631.36
| Professional | | $693.95 | $930.50 | $1,631.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,099.38 / $1,413.49 / $1,457.62
| Professional | | $1,099.38 | $1,413.49 | $1,457.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,195.65 / $3,664.52 / $6,113.61
| Facility | | $2,195.65 | $3,664.52 | $6,113.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.85 / $892.12 / $927.81
| Professional | | $761.85 | $892.12 | $927.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $848.48 / $3,838.00 / $7,799.00
| Facility | | $848.48 | $3,838.00 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $712.10 / $916.35 / $1,799.45
| Professional | | $712.10 | $916.35 | $1,799.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $818.10 / $818.10 / $861.80
| Professional | | $818.10 | $818.10 | $861.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,336.65 / $1,336.65 / $1,336.65
| Facility | | $1,336.65 | $1,336.65 | $1,336.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $725.15 / $944.44 / $1,656.90
| Professional | | $725.15 | $944.44 | $1,656.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $770.11 / $800.92 / $918.21
| Facility | | $770.11 | $800.92 | $918.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $769.01 / $881.28 / $960.93
| Professional | | $769.01 | $881.28 | $960.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.00 / $2,391.00 / $6,000.00
| Facility | | $637.00 | $2,391.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $783.63 / $968.02 / $1,720.37
| Professional | | $783.63 | $968.02 | $1,720.37 |