- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $859.17 / $3,596.00 / $10,893.00
| Facility | | $859.17 | $3,596.00 | $10,893.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $734.43 / $859.17 / $1,029.18
| Professional | | $734.43 | $859.17 | $1,029.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.32 / $1,331.14 / $5,646.00
| Facility | | $800.32 | $1,331.14 | $5,646.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $696.08 / $848.87 / $1,196.10
| Professional | | $696.08 | $848.87 | $1,196.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $662.84 / $662.84 / $662.84
| Facility | | $662.84 | $662.84 | $662.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $790.30 / $1,033.81 / $1,657.89
| Professional | | $790.30 | $1,033.81 | $1,657.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $9,392.57
| Facility | | $55.00 | $55.00 | $9,392.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,373.28 / $5,521.36 / $6,503.63
| Professional | | $5,373.28 | $5,521.36 | $6,503.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $733.27 / $869.33 / $1,774.97
| Facility | | $733.27 | $869.33 | $1,774.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $961.27 / $1,109.16 / $1,294.02
| Professional | | $961.27 | $1,109.16 | $1,294.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $733.27 / $873.28 / $1,954.75
| Facility | | $733.27 | $873.28 | $1,954.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $790.30 / $1,073.96 / $1,802.75
| Professional | | $790.30 | $1,073.96 | $1,802.75 |
- 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
- $640.16 / $838.42 / $1,319.91
| Professional | | $640.16 | $838.42 | $1,319.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.09 / $723.46 / $988.98
| Professional | | $631.09 | $723.46 | $988.98 |