- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.00 / $1,473.20 / $3,363.00
| Facility | | $537.00 | $1,473.20 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.81 / $571.94 / $1,395.56
| Professional | | $395.81 | $571.94 | $1,395.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $2,681.04 / $4,755.00
| Facility | | $818.35 | $2,681.04 | $4,755.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.74 / $1,062.58 / $3,853.12
| Professional | | $506.74 | $1,062.58 | $3,853.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.14 / $815.28 / $1,438.66
| Facility | | $627.14 | $815.28 | $1,438.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $765.59 / $1,149.80 / $1,602.47
| Professional | | $765.59 | $1,149.80 | $1,602.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $612.05 / $954.95 / $1,984.49
| Professional | | $612.05 | $954.95 | $1,984.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $529.54 / $1,143.52 / $6,679.00
| Facility | | $529.54 | $1,143.52 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $708.77 / $889.92 / $1,228.44
| Professional | | $708.77 | $889.92 | $1,228.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $654.95 / $1,345.94 / $1,857.50
| Professional | | $654.95 | $1,345.94 | $1,857.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $906.72 / $906.72 / $906.72
| Facility | | $906.72 | $906.72 | $906.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,030.00 / $1,030.00 / $1,581.18
| Professional | | $1,030.00 | $1,030.00 | $1,581.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,681.04 / $8,498.00
| Facility | | $55.00 | $2,681.04 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $740.30 / $1,245.83 / $5,231.41
| Professional | | $740.30 | $1,245.83 | $5,231.41 |
- 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
- $684.18 / $969.56 / $1,715.52
| Professional | | $684.18 | $969.56 | $1,715.52 |