- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $772.77 / $2,673.00 / $7,495.00
| Facility | | $772.77 | $2,673.00 | $7,495.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $755.46 / $839.02 / $1,161.73
| Professional | | $755.46 | $839.02 | $1,161.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,126.83 / $6,220.48 / $13,341.71
| Facility | | $3,126.83 | $6,220.48 | $13,341.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $717.17 / $751.42 / $866.61
| Professional | | $717.17 | $751.42 | $866.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $705.57 / $705.57 / $705.57
| Facility | | $705.57 | $705.57 | $705.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,619.61 / $3,619.61 / $3,619.61
| Facility | | $3,619.61 | $3,619.61 | $3,619.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $813.93 / $1,072.95 / $1,656.72
| Professional | | $813.93 | $1,072.95 | $1,656.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,500.00 / $16,394.00 / $16,394.00
| Facility | | $11,500.00 | $16,394.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,010.07 / $9,010.07 / $9,010.07
| Professional | | $9,010.07 | $9,010.07 | $9,010.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $784.89 / $1,045.35 / $1,886.85
| Facility | | $784.89 | $1,045.35 | $1,886.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,005.42 / $1,183.30 / $1,392.12
| Professional | | $1,005.42 | $1,183.30 | $1,392.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,157.40 / $1,157.40 / $1,157.40
| Professional | | $1,157.40 | $1,157.40 | $1,157.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $784.89 / $1,051.18 / $2,070.00
| Facility | | $784.89 | $1,051.18 | $2,070.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $813.93 / $1,086.43 / $1,801.78
| Professional | | $813.93 | $1,086.43 | $1,801.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,688.00 / $5,125.00 / $10,600.00
| Facility | | $1,688.00 | $5,125.00 | $10,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $663.47 / $912.27 / $1,409.88
| Professional | | $663.47 | $912.27 | $1,409.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.07 / $755.55 / $1,044.13
| Professional | | $660.07 | $755.55 | $1,044.13 |