- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $775.06 / $3,511.00 / $12,040.00
| Facility | | $775.06 | $3,511.00 | $12,040.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.45 / $671.58 / $1,029.58
| Professional | | $457.45 | $671.58 | $1,029.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.31 / $8,793.46 / $15,732.53
| Facility | | $3,090.31 | $8,793.46 | $15,732.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.97 / $726.10 / $1,006.69
| Professional | | $482.97 | $726.10 | $1,006.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $483.11 / $488.77
| Facility | | $80.00 | $483.11 | $488.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $883.51 / $883.51 / $883.51
| Facility | | $883.51 | $883.51 | $883.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $502.72 / $767.84 / $1,212.21
| Professional | | $502.72 | $767.84 | $1,212.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,452.23 / $11,500.00 / $26,542.00
| Facility | | $2,452.23 | $11,500.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,787.52 / $5,615.12 / $6,681.45
| Professional | | $3,787.52 | $5,615.12 | $6,681.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $521.39 / $776.23 / $1,189.85
| Facility | | $521.39 | $776.23 | $1,189.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $671.13 / $960.23 / $1,375.24
| Professional | | $671.13 | $960.23 | $1,375.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $503.90 / $862.16 / $1,960.50
| Professional | | $503.90 | $862.16 | $1,960.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $521.49 / $784.59 / $1,232.85
| Facility | | $521.49 | $784.59 | $1,232.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.77 / $803.93 / $1,383.37
| Professional | | $526.77 | $803.93 | $1,383.37 |
- 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
- $520.28 / $703.47 / $1,098.20
| Professional | | $520.28 | $703.47 | $1,098.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $652.07 / $733.09 / $1,032.18
| Professional | | $652.07 | $733.09 | $1,032.18 |