- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $732.00 / $2,172.00 / $7,513.00
| Facility | | $732.00 | $2,172.00 | $7,513.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $805.17 / $938.75 / $1,285.85
| Professional | | $805.17 | $938.75 | $1,285.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,890.70 / $6,093.53 / $12,694.86
| Facility | | $2,890.70 | $6,093.53 | $12,694.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $772.94 / $772.94 / $772.94
| Facility | | $772.94 | $772.94 | $772.94 |
- 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
- $893.71 / $1,177.46 / $1,784.99
| Professional | | $893.71 | $1,177.46 | $1,784.99 |
- 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
- $6,364.24 / $6,506.48 / $7,261.43
| Professional | | $6,364.24 | $6,506.48 | $7,261.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $829.59 / $1,103.34 / $1,935.28
| Facility | | $829.59 | $1,103.34 | $1,935.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,103.40 / $1,298.61 / $1,527.79
| Professional | | $1,103.40 | $1,298.61 | $1,527.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,225.00 / $1,225.00 / $1,225.00
| Professional | | $1,225.00 | $1,225.00 | $1,225.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $829.59 / $1,107.17 / $2,213.90
| Facility | | $829.59 | $1,107.17 | $2,213.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $893.71 / $1,195.17 / $1,839.42
| Professional | | $893.71 | $1,195.17 | $1,839.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.00 / $3,347.00 / $18,325.00
| Facility | | $1,154.00 | $3,347.00 | $18,325.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $720.95 / $1,003.59 / $1,588.00
| Professional | | $720.95 | $1,003.59 | $1,588.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.40 / $829.59 / $1,145.79
| Professional | | $724.40 | $829.59 | $1,145.79 |