- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $850.08 / $3,745.00 / $8,017.00
| Facility | | $850.08 | $3,745.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $774.28 / $839.79 / $1,491.89
| Professional | | $774.28 | $839.79 | $1,491.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.35 / $6,182.00 / $17,094.48
| Facility | | $5,058.35 | $6,182.00 | $17,094.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $931.53 / $966.68 / $966.68
| Professional | | $931.53 | $966.68 | $966.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.65 / $1,003.06 / $1,734.63
| Professional | | $745.65 | $1,003.06 | $1,734.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,115.38 / $1,434.06 / $1,484.13
| Professional | | $1,115.38 | $1,434.06 | $1,484.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,913.45 / $8,913.45 / $8,913.45
| Facility | | $8,913.45 | $8,913.45 | $8,913.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.00 / $3,964.00 / $8,017.00
| Facility | | $954.00 | $3,964.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $806.26 / $948.58 / $4,917.20
| Professional | | $806.26 | $948.58 | $4,917.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.70 / $831.70 / $869.50
| Professional | | $831.70 | $831.70 | $869.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,052.33 / $1,052.33 / $1,052.33
| Facility | | $1,052.33 | $1,052.33 | $1,052.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $798.84 / $1,012.51 / $1,868.16
| Professional | | $798.84 | $1,012.51 | $1,868.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $908.19 / $908.19 / $924.12
| Facility | | $908.19 | $908.19 | $924.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $908.19 / $911.78 / $962.15
| Professional | | $908.19 | $911.78 | $962.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.00 / $2,884.00 / $6,000.00
| Facility | | $1,122.00 | $2,884.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $763.25 / $990.98 / $1,767.43
| Professional | | $763.25 | $990.98 | $1,767.43 |