- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $803.00 / $2,594.00 / $7,542.00
| Facility | | $803.00 | $2,594.00 | $7,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $943.45 / $1,063.38 / $1,596.74
| Professional | | $943.45 | $1,063.38 | $1,596.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $939.10 / $1,188.98 / $1,656.08
| Professional | | $939.10 | $1,188.98 | $1,656.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $862.44 / $862.44 / $878.22
| Facility | | $862.44 | $862.44 | $878.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,024.00 / $4,619.00
| Facility | | $900.00 | $2,024.00 | $4,619.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $961.77 / $1,335.31 / $2,118.81
| Professional | | $961.77 | $1,335.31 | $2,118.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $8,142.19
| Facility | | $55.00 | $55.00 | $8,142.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,392.08 / $7,582.64 / $8,563.50
| Professional | | $7,392.08 | $7,582.64 | $8,563.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $972.96 / $1,179.30 / $2,146.01
| Facility | | $972.96 | $1,179.30 | $2,146.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,142.35 / $1,519.84 / $1,847.65
| Professional | | $1,142.35 | $1,519.84 | $1,847.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $1,107.09 / $2,566.80
| Professional | | $6.00 | $1,107.09 | $2,566.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.50 / $1,182.59 / $2,282.80
| Facility | | $977.50 | $1,182.59 | $2,282.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.56 / $1,407.56 / $2,512.35
| Professional | | $1,000.56 | $1,407.56 | $2,512.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,190.00 / $3,293.00 / $7,600.00
| Facility | | $1,190.00 | $3,293.00 | $7,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $823.55 / $1,102.72 / $1,743.54
| Professional | | $823.55 | $1,102.72 | $1,743.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $847.80 / $990.92 / $1,339.62
| Professional | | $847.80 | $990.92 | $1,339.62 |