- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $546.72 / $2,747.00 / $5,011.00
| Facility | | $546.72 | $2,747.00 | $5,011.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.02 / $580.73 / $881.49
| Professional | | $468.02 | $580.73 | $881.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $935.17 / $3,312.06 / $26,542.00
| Facility | | $935.17 | $3,312.06 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.54 / $1,097.08 / $4,206.72
| Professional | | $553.54 | $1,097.08 | $4,206.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $855.84 / $1,695.28 / $1,695.28
| Professional | | $855.84 | $1,695.28 | $1,695.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $837.00 / $920.70 / $3,111.82
| Facility | | $837.00 | $920.70 | $3,111.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $495.99 / $969.25 / $2,058.08
| Professional | | $495.99 | $969.25 | $2,058.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $586.42 / $1,268.76 / $6,679.00
| Facility | | $586.42 | $1,268.76 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $672.93 / $856.41 / $1,237.04
| Professional | | $672.93 | $856.41 | $1,237.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $734.00 / $1,448.92 / $1,919.48
| Professional | | $734.00 | $1,448.92 | $1,919.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,231.20 / $4,231.20 / $5,007.66
| Facility | | $4,231.20 | $4,231.20 | $5,007.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $952.63 / $952.63 / $952.63
| Professional | | $952.63 | $952.63 | $952.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $4,249.00 / $26,542.00
| Facility | | $1,061.00 | $4,249.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.79 / $1,097.08 / $4,206.72
| Professional | | $592.79 | $1,097.08 | $4,206.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $2,854.00 / $5,714.00
| Facility | | $1,061.00 | $2,854.00 | $5,714.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $568.95 / $856.53 / $2,066.69
| Professional | | $568.95 | $856.53 | $2,066.69 |