- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.98 / $3,730.00 / $12,941.00
| Facility | | $707.98 | $3,730.00 | $12,941.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.71 / $644.94 / $1,012.88
| Professional | | $504.71 | $644.94 | $1,012.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,221.05 / $4,149.00 / $8,072.00
| Facility | | $2,221.05 | $4,149.00 | $8,072.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $481.43 / $618.72 / $1,004.99
| Professional | | $481.43 | $618.72 | $1,004.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $476.14 / $478.29
| Facility | | $80.00 | $476.14 | $478.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $902.78 / $902.78 / $902.78
| Facility | | $902.78 | $902.78 | $902.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.51 / $846.57 / $1,342.53
| Professional | | $579.51 | $846.57 | $1,342.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,698.94 / $11,500.00 / $26,542.00
| Facility | | $3,698.94 | $11,500.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,710.00 / $5,790.42 / $5,790.42
| Professional | | $5,710.00 | $5,790.42 | $5,790.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $543.40 / $800.84 / $1,366.09
| Facility | | $543.40 | $800.84 | $1,366.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $679.95 / $863.02 / $1,120.23
| Professional | | $679.95 | $863.02 | $1,120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $740.10 / $740.10 / $740.10
| Professional | | $740.10 | $740.10 | $740.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $546.33 / $809.97 / $1,398.30
| Facility | | $546.33 | $809.97 | $1,398.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.47 / $884.32 / $1,369.49
| Professional | | $597.47 | $884.32 | $1,369.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.00 / $3,239.00 / $7,600.00
| Facility | | $1,154.00 | $3,239.00 | $7,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $566.27 / $768.40 / $1,192.69
| Professional | | $566.27 | $768.40 | $1,192.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.16 / $601.75 / $843.21
| Professional | | $531.16 | $601.75 | $843.21 |