- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $869.97 / $2,747.00 / $8,017.00
| Facility | | $869.97 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $722.99 / $897.51 / $2,172.63
| Professional | | $722.99 | $897.51 | $2,172.63 |
- 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
- $1,005.82 / $1,043.78 / $1,043.78
| Professional | | $1,005.82 | $1,043.78 | $1,043.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $753.08 / $997.27 / $1,787.08
| Professional | | $753.08 | $997.27 | $1,787.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,207.21 / $1,552.12 / $1,603.00
| Professional | | $1,207.21 | $1,552.12 | $1,603.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,123.40 / $4,551.00 / $6,270.65
| Facility | | $1,123.40 | $4,551.00 | $6,270.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $918.00 / $3,077.00 / $8,017.00
| Facility | | $918.00 | $3,077.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $751.47 / $1,017.78 / $2,333.56
| Professional | | $751.47 | $1,017.78 | $2,333.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,121.90 / $1,121.90 / $1,160.20
| Professional | | $1,121.90 | $1,121.90 | $1,160.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,422.45 / $1,422.45 / $1,422.45
| Facility | | $1,422.45 | $1,422.45 | $1,422.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $779.10 / $1,031.29 / $1,914.62
| Professional | | $779.10 | $1,031.29 | $1,914.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.83 / $817.82 / $981.91
| Facility | | $791.83 | $817.82 | $981.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $795.87 / $865.80 / $1,046.42
| Professional | | $795.87 | $865.80 | $1,046.42 |
- 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
- $846.60 / $1,084.52 / $1,943.95
| Professional | | $846.60 | $1,084.52 | $1,943.95 |