- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $678.51 / $2,673.00 / $7,542.00
| Facility | | $678.51 | $2,673.00 | $7,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $566.19 / $678.51 / $1,091.57
| Professional | | $566.19 | $678.51 | $1,091.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,200.00 / $8,318.61 / $16,416.84
| Facility | | $4,200.00 | $8,318.61 | $16,416.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.11 / $694.06 / $1,071.50
| Professional | | $567.11 | $694.06 | $1,071.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $690.16 / $713.89
| Facility | | $80.00 | $690.16 | $713.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $781.03 / $781.03 / $781.03
| Facility | | $781.03 | $781.03 | $781.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.58 / $897.48 / $1,346.10
| Professional | | $660.58 | $897.48 | $1,346.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $20,174.84
| Facility | | $55.00 | $55.00 | $20,174.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,766.24 / $4,930.88 / $5,990.78
| Professional | | $4,766.24 | $4,930.88 | $5,990.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $609.42 / $751.46 / $1,305.24
| Facility | | $609.42 | $751.46 | $1,305.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $835.75 / $1,022.96 / $1,243.59
| Professional | | $835.75 | $1,022.96 | $1,243.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $704.00 / $704.00 / $704.00
| Professional | | $704.00 | $704.00 | $704.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $609.42 / $760.69 / $1,341.45
| Facility | | $609.42 | $760.69 | $1,341.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $679.46 / $921.62 / $1,366.51
| Professional | | $679.46 | $921.62 | $1,366.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,093.00 / $6,000.00 / $13,134.00
| Facility | | $2,093.00 | $6,000.00 | $13,134.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.09 / $703.39 / $1,130.84
| Professional | | $530.09 | $703.39 | $1,130.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.63 / $646.95 / $892.98
| Professional | | $570.63 | $646.95 | $892.98 |