- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.69 / $3,570.00 / $10,893.00
| Facility | | $891.69 | $3,570.00 | $10,893.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $814.41 / $955.11 / $1,425.17
| Professional | | $814.41 | $955.11 | $1,425.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $985.11 / $1,655.40 / $8,486.19
| Facility | | $985.11 | $1,655.40 | $8,486.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $786.34 / $1,243.16 / $1,943.07
| Professional | | $786.34 | $1,243.16 | $1,943.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $958.63 / $958.63 / $958.63
| Facility | | $958.63 | $958.63 | $958.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,036.08 / $1,341.26 / $1,996.40
| Professional | | $1,036.08 | $1,341.26 | $1,996.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $11,205.00
| Facility | | $55.00 | $55.00 | $11,205.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,562.06 / $7,562.06 / $8,916.53
| Professional | | $7,562.06 | $7,562.06 | $8,916.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $936.90 / $1,235.14 / $2,253.08
| Facility | | $936.90 | $1,235.14 | $2,253.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,080.59 / $1,503.01 / $1,768.25
| Professional | | $1,080.59 | $1,503.01 | $1,768.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,092.63 / $1,096.24 / $1,236.50
| Professional | | $1,092.63 | $1,096.24 | $1,236.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $936.90 / $1,258.23 / $2,311.62
| Facility | | $936.90 | $1,258.23 | $2,311.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,039.93 / $1,375.79 / $2,031.40
| Professional | | $1,039.93 | $1,375.79 | $2,031.40 |
- 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
- $816.48 / $1,117.44 / $1,767.84
| Professional | | $816.48 | $1,117.44 | $1,767.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $838.41 / $950.11 / $1,306.64
| Professional | | $838.41 | $950.11 | $1,306.64 |