- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $964.01 / $3,494.00 / $8,017.00
| Facility | | $964.01 | $3,494.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $755.10 / $885.47 / $1,288.22
| Professional | | $755.10 | $885.47 | $1,288.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,431.95 / $7,827.00 / $19,139.18
| Facility | | $6,431.95 | $7,827.00 | $19,139.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $896.13 / $929.95 / $929.95
| Professional | | $896.13 | $929.95 | $929.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,025.26 / $1,025.26 / $1,025.26
| Facility | | $1,025.26 | $1,025.26 | $1,025.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $839.93 / $1,073.67 / $1,825.09
| Professional | | $839.93 | $1,073.67 | $1,825.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,070.15 / $1,445.88 / $1,848.43
| Professional | | $1,070.15 | $1,445.88 | $1,848.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $3,964.00 / $8,017.00
| Facility | | $1,013.00 | $3,964.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $826.05 / $964.01 / $3,748.00
| Professional | | $826.05 | $964.01 | $3,748.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,057.59 / $1,057.59 / $1,913.90
| Professional | | $1,057.59 | $1,057.59 | $1,913.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,025.26 / $1,025.26 / $1,025.26
| Facility | | $1,025.26 | $1,025.26 | $1,025.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $840.22 / $1,097.95 / $1,873.23
| Professional | | $840.22 | $1,097.95 | $1,873.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.45 / $890.45 / $955.42
| Facility | | $890.45 | $890.45 | $955.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $867.72 / $890.45 / $955.42
| Professional | | $867.72 | $890.45 | $955.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $3,475.00 / $6,368.00
| Facility | | $2,155.00 | $3,475.00 | $6,368.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $800.56 / $1,062.70 / $1,758.64
| Professional | | $800.56 | $1,062.70 | $1,758.64 |