- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $797.00 / $3,213.00 / $10,836.00
| Facility | | $797.00 | $3,213.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.02 / $832.30 / $1,166.97
| Professional | | $737.02 | $832.30 | $1,166.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,771.55 / $3,011.63 / $6,166.00
| Facility | | $1,771.55 | $3,011.63 | $6,166.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $620.13 / $853.83 / $1,583.65
| Professional | | $620.13 | $853.83 | $1,583.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.93 / $710.93 / $710.93
| Facility | | $710.93 | $710.93 | $710.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,377.85 / $1,377.85 / $1,377.85
| Facility | | $1,377.85 | $1,377.85 | $1,377.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $818.76 / $1,086.77 / $1,680.31
| Professional | | $818.76 | $1,086.77 | $1,680.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,444.45 / $26,542.00 / $26,542.00
| Facility | | $5,444.45 | $26,542.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,660.08 / $8,255.64 / $8,528.07
| Professional | | $6,660.08 | $8,255.64 | $8,528.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $785.28 / $1,048.18 / $1,767.19
| Facility | | $785.28 | $1,048.18 | $1,767.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,011.31 / $1,190.23 / $1,400.27
| Professional | | $1,011.31 | $1,190.23 | $1,400.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,249.59 / $1,249.59 / $1,249.59
| Professional | | $1,249.59 | $1,249.59 | $1,249.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $785.28 / $1,050.27 / $2,023.40
| Facility | | $785.28 | $1,050.27 | $2,023.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $819.93 / $1,114.73 / $1,828.93
| Professional | | $819.93 | $1,114.73 | $1,828.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,634.00 / $4,345.00 / $10,600.00
| Facility | | $1,634.00 | $4,345.00 | $10,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $679.80 / $916.64 / $1,429.04
| Professional | | $679.80 | $916.64 | $1,429.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $663.94 / $759.76 / $1,050.27
| Professional | | $663.94 | $759.76 | $1,050.27 |