- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $926.74 / $3,596.00 / $10,836.00
| Facility | | $926.74 | $3,596.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $839.11 / $926.74 / $1,408.55
| Professional | | $839.11 | $926.74 | $1,408.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $944.88 / $1,590.95 / $4,522.50
| Facility | | $944.88 | $1,590.95 | $4,522.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $848.62 / $1,081.53 / $1,488.77
| Professional | | $848.62 | $1,081.53 | $1,488.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $867.19 / $867.19 / $867.19
| Facility | | $867.19 | $867.19 | $867.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $969.58 / $1,257.08 / $1,943.37
| Professional | | $969.58 | $1,257.08 | $1,943.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $8,414.95
| Facility | | $55.00 | $55.00 | $8,414.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,461.00 / $12,818.24 / $12,818.24
| Professional | | $9,461.00 | $12,818.24 | $12,818.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $898.59 / $1,170.85 / $2,081.98
| Facility | | $898.59 | $1,170.85 | $2,081.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,001.61 / $1,393.14 / $1,638.99
| Professional | | $1,001.61 | $1,393.14 | $1,638.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,355.30 / $1,355.30 / $1,355.30
| Professional | | $1,355.30 | $1,355.30 | $1,355.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $898.59 / $1,173.55 / $2,183.71
| Facility | | $898.59 | $1,173.55 | $2,183.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $974.32 / $1,294.79 / $1,980.87
| Professional | | $974.32 | $1,294.79 | $1,980.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $2,000.00 / $8,759.00
| Facility | | $385.00 | $2,000.00 | $8,759.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $757.27 / $1,055.71 / $1,718.19
| Professional | | $757.27 | $1,055.71 | $1,718.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $777.13 / $887.12 / $1,218.69
| Professional | | $777.13 | $887.12 | $1,218.69 |