- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $907.31 / $3,596.00 / $10,836.00
| Facility | | $907.31 | $3,596.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $828.79 / $994.55 / $1,366.37
| Professional | | $828.79 | $994.55 | $1,366.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $926.05 / $1,532.33 / $6,055.00
| Facility | | $926.05 | $1,532.33 | $6,055.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $829.06 / $1,056.59 / $1,472.07
| Professional | | $829.06 | $1,056.59 | $1,472.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $867.73 / $867.73 / $867.73
| Facility | | $867.73 | $867.73 | $867.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $944.48 / $1,238.48 / $1,906.68
| Professional | | $944.48 | $1,238.48 | $1,906.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $16,401.75
| Facility | | $55.00 | $55.00 | $16,401.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,891.71 / $6,891.71 / $7,829.33
| Professional | | $6,891.71 | $6,891.71 | $7,829.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $889.37 / $1,172.70 / $2,011.69
| Facility | | $889.37 | $1,172.70 | $2,011.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $975.99 / $1,357.51 / $1,597.07
| Professional | | $975.99 | $1,357.51 | $1,597.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $863.49 / $938.68 / $1,505.79
| Professional | | $863.49 | $938.68 | $1,505.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.71 / $1,177.76 / $2,327.17
| Facility | | $884.71 | $1,177.76 | $2,327.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $945.52 / $1,256.42 / $2,002.92
| Professional | | $945.52 | $1,256.42 | $2,002.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $2,064.00 / $8,759.00
| Facility | | $385.00 | $2,064.00 | $8,759.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $760.48 / $1,045.66 / $1,616.02
| Professional | | $760.48 | $1,045.66 | $1,616.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $757.25 / $864.32 / $1,187.64
| Professional | | $757.25 | $864.32 | $1,187.64 |