- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $775.29 / $2,747.00 / $5,402.04
| Facility | | $775.29 | $2,747.00 | $5,402.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $749.55 / $906.28 / $1,474.62
| Professional | | $749.55 | $906.28 | $1,474.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,313.00 / $3,997.00 / $6,441.12
| Facility | | $1,313.00 | $3,997.00 | $6,441.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.76 / $1,261.29 / $5,864.00
| Professional | | $675.76 | $1,261.29 | $5,864.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $958.11 / $1,243.63 / $2,197.90
| Facility | | $958.11 | $1,243.63 | $2,197.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,253.90 / $1,714.06 / $2,301.38
| Professional | | $1,253.90 | $1,714.06 | $2,301.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $648.13 / $648.13 / $648.13
| Facility | | $648.13 | $648.13 | $648.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $774.56 / $1,506.52 / $2,783.11
| Professional | | $774.56 | $1,506.52 | $2,783.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $805.31 / $1,747.00 / $6,679.00
| Facility | | $805.31 | $1,747.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $974.44 / $1,223.81 / $1,689.34
| Professional | | $974.44 | $1,223.81 | $1,689.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $986.73 / $2,021.38 / $2,919.46
| Professional | | $986.73 | $2,021.38 | $2,919.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,350.23 / $1,350.23 / $1,384.43
| Professional | | $1,350.23 | $1,350.23 | $1,384.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $4,525.00 / $9,039.00
| Facility | | $1,685.00 | $4,525.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $907.94 / $1,523.04 / $6,944.23
| Professional | | $907.94 | $1,523.04 | $6,944.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,715.00 / $8,766.00
| Facility | | $1,685.00 | $3,715.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $865.34 / $1,258.11 / $2,543.73
| Professional | | $865.34 | $1,258.11 | $2,543.73 |