- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $757.00 / $2,783.00 / $7,542.00
| Facility | | $757.00 | $2,783.00 | $7,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $700.45 / $833.14 / $1,371.46
| Professional | | $700.45 | $833.14 | $1,371.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,348.00 / $4,352.55 / $8,403.96
| Facility | | $2,348.00 | $4,352.55 | $8,403.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $764.27 / $967.38 / $1,301.83
| Professional | | $764.27 | $967.38 | $1,301.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $767.93 / $773.07
| Facility | | $80.00 | $767.93 | $773.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $927.20 / $927.20 / $927.20
| Facility | | $927.20 | $927.20 | $927.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $771.39 / $1,029.47 / $1,552.82
| Professional | | $771.39 | $1,029.47 | $1,552.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,051.56 / $11,500.00 / $16,394.00
| Facility | | $3,051.56 | $11,500.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,909.20 / $6,077.36 / $7,041.38
| Professional | | $5,909.20 | $6,077.36 | $7,041.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $745.72 / $930.15 / $1,435.97
| Facility | | $745.72 | $930.15 | $1,435.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,006.38 / $1,207.65 / $1,497.49
| Professional | | $1,006.38 | $1,207.65 | $1,497.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $880.40 / $880.40 / $880.40
| Professional | | $880.40 | $880.40 | $880.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $745.72 / $937.69 / $1,488.69
| Facility | | $745.72 | $937.69 | $1,488.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.41 / $1,062.15 / $1,601.54
| Professional | | $776.41 | $1,062.15 | $1,601.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $600.00 / $2,064.00 / $4,509.00
| Facility | | $600.00 | $2,064.00 | $4,509.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $609.02 / $820.77 / $1,305.65
| Professional | | $609.02 | $820.77 | $1,305.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.13 / $776.41 / $1,085.36
| Professional | | $687.13 | $776.41 | $1,085.36 |