- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.45 / $3,730.00 / $13,401.00
| Facility | | $875.45 | $3,730.00 | $13,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $769.19 / $875.45 / $1,051.41
| Professional | | $769.19 | $875.45 | $1,051.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $799.56 / $1,348.76 / $7,901.00
| Facility | | $799.56 | $1,348.76 | $7,901.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $711.94 / $901.14 / $1,255.50
| Professional | | $711.94 | $901.14 | $1,255.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.89 / $758.89 / $758.89
| Facility | | $758.89 | $758.89 | $758.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $808.39 / $1,065.25 / $1,712.34
| Professional | | $808.39 | $1,065.25 | $1,712.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $11,933.00 / $14,017.76
| Facility | | $55.00 | $11,933.00 | $14,017.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,508.15 / $8,508.15 / $8,508.15
| Professional | | $8,508.15 | $8,508.15 | $8,508.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $801.14 / $1,017.10 / $2,089.87
| Facility | | $801.14 | $1,017.10 | $2,089.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $983.14 / $1,134.39 / $1,323.46
| Professional | | $983.14 | $1,134.39 | $1,323.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $744.30 / $817.00 / $1,309.36
| Professional | | $744.30 | $817.00 | $1,309.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $801.14 / $1,036.33 / $2,139.28
| Facility | | $801.14 | $1,036.33 | $2,139.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $808.39 / $1,075.79 / $1,730.53
| Professional | | $808.39 | $1,075.79 | $1,730.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $2,064.00 / $8,759.00
| Facility | | $385.00 | $2,064.00 | $8,759.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $651.05 / $817.13 / $1,341.47
| Professional | | $651.05 | $817.13 | $1,341.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.45 / $736.28 / $1,013.86
| Professional | | $645.45 | $736.28 | $1,013.86 |