- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $797.00 / $3,219.00 / $11,453.00
| Facility | | $797.00 | $3,219.00 | $11,453.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.14 / $854.71 / $1,345.17
| Professional | | $724.14 | $854.71 | $1,345.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,436.33 / $4,325.17 / $8,431.35
| Facility | | $2,436.33 | $4,325.17 | $8,431.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $779.84 / $965.55 / $1,354.33
| Professional | | $779.84 | $965.55 | $1,354.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $794.96 / $797.16
| Facility | | $80.00 | $794.96 | $797.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.32 / $950.32 / $950.32
| Facility | | $950.32 | $950.32 | $950.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $809.59 / $1,074.75 / $1,647.53
| Professional | | $809.59 | $1,074.75 | $1,647.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,117.36 / $11,500.00 / $26,542.00
| Facility | | $3,117.36 | $11,500.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,045.52 / $6,232.32 / $7,198.73
| Professional | | $6,045.52 | $6,232.32 | $7,198.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.61 / $1,030.20 / $1,575.68
| Facility | | $796.61 | $1,030.20 | $1,575.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,029.03 / $1,234.83 / $1,531.19
| Professional | | $1,029.03 | $1,234.83 | $1,531.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,035.20 / $1,035.20 / $1,035.20
| Professional | | $1,035.20 | $1,035.20 | $1,035.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $802.37 / $1,030.36 / $1,630.15
| Facility | | $802.37 | $1,030.36 | $1,630.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.57 / $1,099.52 / $1,671.53
| Professional | | $816.57 | $1,099.52 | $1,671.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,634.00 / $4,425.00 / $10,600.00
| Facility | | $1,634.00 | $4,425.00 | $10,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.40 / $852.94 / $1,350.12
| Professional | | $630.40 | $852.94 | $1,350.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $702.59 / $792.61 / $1,110.58
| Professional | | $702.59 | $792.61 | $1,110.58 |