- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $849.42 / $2,252.25 / $6,319.17
| Facility | | $849.42 | $2,252.25 | $6,319.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $720.72 / $952.38 / $1,544.40
| Professional | | $720.72 | $952.38 | $1,544.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.67 / $3,190.33 / $6,640.92
| Facility | | $11.67 | $3,190.33 | $6,640.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $682.11 / $1,801.80
| Professional | | $5.00 | $682.11 | $1,801.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $900.90 / $1,228.95 / $1,801.80
| Professional | | $900.90 | $1,228.95 | $1,801.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,287.00 / $1,287.00 / $1,287.00
| Facility | | $1,287.00 | $1,287.00 | $1,287.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $836.55 / $2,417.63 / $5,562.19
| Facility | | $836.55 | $2,417.63 | $5,562.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $617.76 / $816.76 / $1,953.60
| Professional | | $617.76 | $816.76 | $1,953.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,059.19 / $6,113.25 / $6,113.25
| Facility | | $2,059.19 | $6,113.25 | $6,113.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,435.00 / $6,435.00 / $9,652.50
| Professional | | $6,435.00 | $6,435.00 | $9,652.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $772.20 / $1,287.00 / $1,580.00
| Facility | | $772.20 | $1,287.00 | $1,580.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,287.00 / $1,287.00 / $1,287.00
| Professional | | $1,287.00 | $1,287.00 | $1,287.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $836.55 / $1,544.40 / $2,895.75
| Professional | | $836.55 | $1,544.40 | $2,895.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $772.20 / $1,287.00 / $2,359.07
| Facility | | $772.20 | $1,287.00 | $2,359.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $656.35 / $1,287.00 / $1,953.60
| Professional | | $656.35 | $1,287.00 | $1,953.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.54 / $540.54 / $836.55
| Professional | | $540.54 | $540.54 | $836.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.93 / $514.79 / $1,287.00
| Professional | | $501.93 | $514.79 | $1,287.00 |