- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $880.00 / $3,219.00 / $10,893.00
| Facility | | $880.00 | $3,219.00 | $10,893.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $807.50 / $1,092.40 / $1,642.62
| Professional | | $807.50 | $1,092.40 | $1,642.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,556.83 / $3,174.32 / $6,397.23
| Facility | | $1,556.83 | $3,174.32 | $6,397.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $885.00 / $1,095.76 / $1,500.77
| Professional | | $885.00 | $1,095.76 | $1,500.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $820.89 / $820.89 / $857.53
| Facility | | $820.89 | $820.89 | $857.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,494.86 / $1,494.86 / $1,543.72
| Facility | | $1,494.86 | $1,494.86 | $1,543.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $911.40 / $1,180.07 / $1,729.58
| Professional | | $911.40 | $1,180.07 | $1,729.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,887.55 / $26,542.00 / $26,542.00
| Facility | | $6,887.55 | $26,542.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,068.48 / $7,307.36 / $8,020.95
| Professional | | $7,068.48 | $7,307.36 | $8,020.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.52 / $1,119.88 / $1,699.07
| Facility | | $912.52 | $1,119.88 | $1,699.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $909.33 / $1,220.73 / $1,596.33
| Professional | | $909.33 | $1,220.73 | $1,596.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $801.82 / $888.67 / $1,007.13
| Professional | | $801.82 | $888.67 | $1,007.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $917.45 / $1,126.09 / $1,837.34
| Facility | | $917.45 | $1,126.09 | $1,837.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $911.21 / $1,236.21 / $1,834.37
| Professional | | $911.21 | $1,236.21 | $1,834.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.00 / $949.00 / $2,287.00
| Facility | | $157.00 | $949.00 | $2,287.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $740.87 / $973.52 / $1,460.28
| Professional | | $740.87 | $973.52 | $1,460.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $801.43 / $909.33 / $1,273.17
| Professional | | $801.43 | $909.33 | $1,273.17 |