- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $916.27 / $3,682.00 / $12,826.00
| Facility | | $916.27 | $3,682.00 | $12,826.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $689.22 / $785.10 / $1,281.46
| Professional | | $689.22 | $785.10 | $1,281.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,443.88 / $7,111.00 / $14,115.04
| Facility | | $3,443.88 | $7,111.00 | $14,115.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.03 / $890.72 / $1,327.91
| Professional | | $605.03 | $890.72 | $1,327.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $680.02 / $680.02
| Facility | | $80.00 | $680.02 | $680.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $853.33 / $853.33 / $853.33
| Facility | | $853.33 | $853.33 | $853.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $763.56 / $992.63 / $1,579.66
| Professional | | $763.56 | $992.63 | $1,579.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,206.78 / $16,547.20 / $26,542.00
| Facility | | $4,206.78 | $16,547.20 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,506.44 / $5,642.56 / $6,428.18
| Professional | | $5,506.44 | $5,642.56 | $6,428.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $698.42 / $966.04 / $1,524.63
| Facility | | $698.42 | $966.04 | $1,524.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $927.54 / $1,113.05 / $1,380.18
| Professional | | $927.54 | $1,113.05 | $1,380.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $740.50 / $740.50 / $740.50
| Professional | | $740.50 | $740.50 | $740.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.09 / $976.42 / $1,609.17
| Facility | | $707.09 | $976.42 | $1,609.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $770.14 / $1,059.40 / $1,632.07
| Professional | | $770.14 | $1,059.40 | $1,632.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.00 / $3,326.00 / $7,600.00
| Facility | | $1,154.00 | $3,326.00 | $7,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.97 / $811.31 / $1,302.50
| Professional | | $614.97 | $811.31 | $1,302.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $633.29 / $715.90 / $1,003.20
| Professional | | $633.29 | $715.90 | $1,003.20 |