- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.24 / $2,747.00 / $8,247.00
| Facility | | $945.24 | $2,747.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $800.95 / $895.41 / $1,436.62
| Professional | | $800.95 | $895.41 | $1,436.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,531.00 / $27,840.00 / $46,296.00
| Facility | | $13,531.00 | $27,840.00 | $46,296.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $922.92 / $957.75 / $957.75
| Professional | | $922.92 | $957.75 | $957.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,050.24 / $1,050.24 / $1,050.24
| Facility | | $1,050.24 | $1,050.24 | $1,050.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $797.46 / $1,134.09 / $1,849.24
| Professional | | $797.46 | $1,134.09 | $1,849.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,086.45 / $1,494.50 / $1,876.59
| Professional | | $1,086.45 | $1,494.50 | $1,876.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.24 / $4,761.00 / $8,427.00
| Facility | | $945.24 | $4,761.00 | $8,427.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $800.95 / $962.40 / $4,747.83
| Professional | | $800.95 | $962.40 | $4,747.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.70 / $977.70 / $1,868.70
| Professional | | $977.70 | $977.70 | $1,868.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,050.24 / $1,050.24 / $1,050.24
| Facility | | $1,050.24 | $1,050.24 | $1,050.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $822.55 / $1,146.08 / $1,849.24
| Professional | | $822.55 | $1,146.08 | $1,849.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $902.07 / $902.07 / $1,037.08
| Facility | | $902.07 | $902.07 | $1,037.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $865.13 / $915.97 / $1,037.08
| Professional | | $865.13 | $915.97 | $1,037.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.00 / $2,391.00 / $6,322.00
| Facility | | $448.00 | $2,391.00 | $6,322.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $873.60 / $1,161.50 / $1,818.99
| Professional | | $873.60 | $1,161.50 | $1,818.99 |