- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $735.71 / $2,673.00 / $7,495.00
| Facility | | $735.71 | $2,673.00 | $7,495.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $735.71 / $857.64 / $1,145.70
| Professional | | $735.71 | $857.64 | $1,145.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,393.73 / $6,347.43 / $12,610.23
| Facility | | $3,393.73 | $6,347.43 | $12,610.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.42 / $853.11 / $1,278.83
| Professional | | $641.42 | $853.11 | $1,278.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $708.41 / $708.41 / $708.41
| Facility | | $708.41 | $708.41 | $708.41 |
- 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
- $817.63 / $1,078.11 / $1,663.52
| Professional | | $817.63 | $1,078.11 | $1,663.52 |
- 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
- $5,822.80 / $5,951.76 / $6,645.23
| Professional | | $5,822.80 | $5,951.76 | $6,645.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $783.48 / $1,028.46 / $1,769.50
| Facility | | $783.48 | $1,028.46 | $1,769.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,009.63 / $1,188.26 / $1,397.95
| Professional | | $1,009.63 | $1,188.26 | $1,397.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,232.40 / $1,232.40 / $1,232.40
| Professional | | $1,232.40 | $1,232.40 | $1,232.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $783.48 / $1,028.46 / $2,021.68
| Facility | | $783.48 | $1,028.46 | $2,021.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $817.63 / $1,095.44 / $1,679.85
| Professional | | $817.63 | $1,095.44 | $1,679.85 |
- 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
- $667.22 / $917.43 / $1,477.90
| Professional | | $667.22 | $917.43 | $1,477.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $662.84 / $758.96 / $1,048.44
| Professional | | $662.84 | $758.96 | $1,048.44 |