- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $712.92 / $1,489.86 / $14,482.00
| Facility | | $712.92 | $1,489.86 | $14,482.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $690.94 / $736.73 / $3,270.52
| Professional | | $690.94 | $736.73 | $3,270.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $683.15 / $1,425.84 / $4,426.96
| Professional | | $683.15 | $1,425.84 | $4,426.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,865.32 / $2,179.77 / $3,343.83
| Facility | | $1,865.32 | $2,179.77 | $3,343.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,112.80 / $2,891.70 / $3,286.03
| Professional | | $1,112.80 | $2,891.70 | $3,286.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $712.92 / $956.41 / $1,575.55
| Facility | | $712.92 | $956.41 | $1,575.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $712.92 / $1,169.06 / $1,789.00
| Facility | | $712.92 | $1,169.06 | $1,789.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $797.39 / $1,376.38 / $5,459.28
| Professional | | $797.39 | $1,376.38 | $5,459.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.32 / $761.01 / $1,807.14
| Professional | | $418.32 | $761.01 | $1,807.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $712.92 / $956.41 / $1,575.55
| Facility | | $712.92 | $956.41 | $1,575.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,217.16 / $1,777.96 / $2,559.64
| Professional | | $1,217.16 | $1,777.96 | $2,559.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,412.14 / $3,412.14 / $3,412.14
| Facility | | $3,412.14 | $3,412.14 | $3,412.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,312.31 / $3,421.05 / $5,459.28
| Professional | | $1,312.31 | $3,421.05 | $5,459.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,374.51 / $2,374.51 / $2,374.51
| Professional | | $2,374.51 | $2,374.51 | $2,374.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,807.27 / $4,601.97 / $4,601.97
| Professional | | $2,807.27 | $4,601.97 | $4,601.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,034.00 / $1,423.00 / $2,202.90
| Facility | | $1,034.00 | $1,423.00 | $2,202.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $783.31 / $1,491.94 / $3,221.17
| Professional | | $783.31 | $1,491.94 | $3,221.17 |