- 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
- $726.25 / $843.54 / $1,159.73
| Professional | | $726.25 | $843.54 | $1,159.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,553.87 / $5,131.52 / $7,485.98
| Facility | | $1,553.87 | $5,131.52 | $7,485.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $715.33 / $905.43 / $1,261.47
| Professional | | $715.33 | $905.43 | $1,261.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $699.26 / $699.26 / $699.26
| Facility | | $699.26 | $699.26 | $699.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,376.10 / $2,376.10 / $2,376.10
| Facility | | $2,376.10 | $2,376.10 | $2,376.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $806.36 / $1,059.96 / $1,605.98
| Professional | | $806.36 | $1,059.96 | $1,605.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,388.90 / $26,542.00 / $26,542.00
| Facility | | $9,388.90 | $26,542.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,739.76 / $5,867.44 / $6,557.63
| Professional | | $5,739.76 | $5,867.44 | $6,557.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.01 / $1,013.39 / $1,741.22
| Facility | | $773.01 | $1,013.39 | $1,741.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $995.76 / $1,171.93 / $1,378.75
| Professional | | $995.76 | $1,171.93 | $1,378.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,120.90 / $1,120.90 / $1,120.90
| Professional | | $1,120.90 | $1,120.90 | $1,120.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.01 / $1,013.39 / $1,994.22
| Facility | | $773.01 | $1,013.39 | $1,994.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $806.36 / $1,075.56 / $1,656.36
| Professional | | $806.36 | $1,075.56 | $1,656.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.00 / $3,314.00 / $7,600.00
| Facility | | $1,154.00 | $3,314.00 | $7,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $656.83 / $869.39 / $1,395.77
| Professional | | $656.83 | $869.39 | $1,395.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $653.73 / $748.21 / $1,034.03
| Professional | | $653.73 | $748.21 | $1,034.03 |