- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.62 / $3,511.00 / $11,232.00
| Facility | | $945.62 | $3,511.00 | $11,232.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.03 / $910.41 / $1,184.23
| Professional | | $759.03 | $910.41 | $1,184.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,252.01 / $7,615.33 / $14,212.05
| Facility | | $4,252.01 | $7,615.33 | $14,212.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.65 / $961.53 / $1,095.55
| Professional | | $759.65 | $961.53 | $1,095.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $708.93 / $708.93 / $708.93
| Facility | | $708.93 | $708.93 | $708.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,187.68 / $4,187.68 / $4,187.68
| Facility | | $4,187.68 | $4,187.68 | $4,187.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.79 / $1,059.92 / $1,609.82
| Professional | | $812.79 | $1,059.92 | $1,609.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,500.00 / $26,542.00 / $30,160.00
| Facility | | $11,500.00 | $26,542.00 | $30,160.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,865.20 / $6,087.44 / $6,839.33
| Professional | | $5,865.20 | $6,087.44 | $6,839.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.88 / $1,028.18 / $1,698.44
| Facility | | $791.88 | $1,028.18 | $1,698.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,027.30 / $1,209.05 / $1,422.41
| Professional | | $1,027.30 | $1,209.05 | $1,422.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $987.57 / $1,035.59 / $1,069.63
| Professional | | $987.57 | $1,035.59 | $1,069.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.88 / $1,043.43 / $2,002.58
| Facility | | $791.88 | $1,043.43 | $2,002.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $815.32 / $1,071.15 / $1,671.83
| Professional | | $815.32 | $1,071.15 | $1,671.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,093.00 / $6,000.00 / $13,134.00
| Facility | | $2,093.00 | $6,000.00 | $13,134.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $652.79 / $881.27 / $1,387.18
| Professional | | $652.79 | $881.27 | $1,387.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $674.43 / $764.02 / $1,067.73
| Professional | | $674.43 | $764.02 | $1,067.73 |