- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $922.04 / $3,682.00 / $10,836.00
| Facility | | $922.04 | $3,682.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $874.02 / $1,027.41 / $1,233.61
| Professional | | $874.02 | $1,027.41 | $1,233.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $841.22 / $1,064.78 / $1,416.79
| Professional | | $841.22 | $1,064.78 | $1,416.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $865.06 / $865.06 / $865.06
| Facility | | $865.06 | $865.06 | $865.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $952.75 / $1,246.79 / $1,956.12
| Professional | | $952.75 | $1,246.79 | $1,956.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $16,479.68
| Facility | | $55.00 | $55.00 | $16,479.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,462.56 / $6,618.88 / $7,877.48
| Professional | | $6,462.56 | $6,618.88 | $7,877.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $887.31 / $1,115.88 / $2,062.89
| Facility | | $887.31 | $1,115.88 | $2,062.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,160.17 / $1,338.66 / $1,561.77
| Professional | | $1,160.17 | $1,338.66 | $1,561.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $903.85 / $1,120.74 / $2,111.54
| Facility | | $903.85 | $1,120.74 | $2,111.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $952.75 / $1,282.00 / $2,165.10
| Professional | | $952.75 | $1,282.00 | $2,165.10 |
- 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
- $732.02 / $1,019.73 / $1,625.83
| Professional | | $732.02 | $1,019.73 | $1,625.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.67 / $870.74 / $1,193.63
| Professional | | $761.67 | $870.74 | $1,193.63 |