- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.09 / $2,172.00 / $7,513.00
| Facility | | $593.09 | $2,172.00 | $7,513.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $576.83 / $633.41 / $897.09
| Professional | | $576.83 | $633.41 | $897.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,890.70 / $6,347.43 / $12,314.01
| Facility | | $2,890.70 | $6,347.43 | $12,314.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $481.35 / $640.19 / $959.67
| Professional | | $481.35 | $640.19 | $959.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $522.40 / $522.40 / $522.40
| Facility | | $522.40 | $522.40 | $522.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,619.61 / $3,619.61 / $3,619.61
| Facility | | $3,619.61 | $3,619.61 | $3,619.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $621.79 / $810.99 / $1,235.33
| Professional | | $621.79 | $810.99 | $1,235.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $14,302.50
| Facility | | $55.00 | $55.00 | $14,302.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,359.92 / $4,459.84 / $4,957.43
| Professional | | $4,359.92 | $4,459.84 | $4,957.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $581.72 / $786.96 / $1,343.93
| Facility | | $581.72 | $786.96 | $1,343.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $754.81 / $888.35 / $1,045.11
| Professional | | $754.81 | $888.35 | $1,045.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $854.30 / $854.30 / $854.30
| Professional | | $854.30 | $854.30 | $854.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $581.72 / $802.42 / $1,517.12
| Facility | | $581.72 | $802.42 | $1,517.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $623.33 / $835.53 / $1,268.65
| Professional | | $623.33 | $835.53 | $1,268.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $564.00 / $2,064.00 / $4,509.00
| Facility | | $564.00 | $2,064.00 | $4,509.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.12 / $703.77 / $1,075.51
| Professional | | $506.12 | $703.77 | $1,075.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $495.54 / $569.24 / $783.27
| Professional | | $495.54 | $569.24 | $783.27 |