- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.71 / $667.84 / $1,961.00
| Facility | | $500.71 | $667.84 | $1,961.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $559.32 / $1,537.13 / $3,333.00
| Professional | | $559.32 | $1,537.13 | $3,333.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $2,592.40 / $4,050.00
| Facility | | $789.00 | $2,592.40 | $4,050.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $826.22 / $1,719.98 / $7,247.84
| Professional | | $826.22 | $1,719.98 | $7,247.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $894.11 / $1,162.33 / $2,051.09
| Facility | | $894.11 | $1,162.33 | $2,051.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,135.80 / $1,722.97 / $2,527.65
| Professional | | $1,135.80 | $1,722.97 | $2,527.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $943.90 / $1,695.03 / $2,824.40
| Professional | | $943.90 | $1,695.03 | $2,824.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,222.74 / $8,090.00
| Facility | | $300.00 | $1,222.74 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.37 / $1,160.40 / $1,830.85
| Professional | | $626.37 | $1,160.40 | $1,830.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,003.83 / $2,109.92 / $2,922.62
| Professional | | $1,003.83 | $2,109.92 | $2,922.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,252.88 / $1,809.41 / $2,936.16
| Professional | | $1,252.88 | $1,809.41 | $2,936.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $5,876.00
| Facility | | $55.00 | $2,854.00 | $5,876.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $893.11 / $2,288.96 / $7,247.84
| Professional | | $893.11 | $2,288.96 | $7,247.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,325.00 / $4,662.00
| Facility | | $953.00 | $3,325.00 | $4,662.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $826.22 / $1,271.81 / $2,970.69
| Professional | | $826.22 | $1,271.81 | $2,970.69 |