- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $788.71 / $3,352.00 / $11,453.00
| Facility | | $788.71 | $3,352.00 | $11,453.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $667.85 / $762.22 / $1,289.73
| Professional | | $667.85 | $762.22 | $1,289.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,656.37 / $9,032.74 / $17,886.03
| Facility | | $4,656.37 | $9,032.74 | $17,886.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $695.32 / $880.11 / $1,199.30
| Professional | | $695.32 | $880.11 | $1,199.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $685.63 / $697.29
| Facility | | $80.00 | $685.63 | $697.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $855.57 / $855.57 / $855.57
| Facility | | $855.57 | $855.57 | $855.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $742.90 / $997.28 / $1,549.41
| Professional | | $742.90 | $997.28 | $1,549.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,532.85 / $19,913.50 / $26,542.00
| Facility | | $3,532.85 | $19,913.50 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,455.60 / $5,560.32 / $6,505.95
| Professional | | $5,455.60 | $5,560.32 | $6,505.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $727.97 / $942.81 / $1,540.47
| Facility | | $727.97 | $942.81 | $1,540.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $929.96 / $1,115.96 / $1,383.78
| Professional | | $929.96 | $1,115.96 | $1,383.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $785.42 / $979.50 / $1,696.39
| Professional | | $785.42 | $979.50 | $1,696.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $727.97 / $942.81 / $1,551.27
| Facility | | $727.97 | $942.81 | $1,551.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $764.78 / $1,034.22 / $1,571.57
| Professional | | $764.78 | $1,034.22 | $1,571.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,093.00 / $5,918.00 / $12,900.00
| Facility | | $2,093.00 | $5,918.00 | $12,900.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.26 / $816.61 / $1,253.77
| Professional | | $592.26 | $816.61 | $1,253.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $634.96 / $720.52 / $1,001.20
| Professional | | $634.96 | $720.52 | $1,001.20 |