- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $887.16 / $3,596.00 / $10,836.00
| Facility | | $887.16 | $3,596.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $797.07 / $910.50 / $1,096.01
| Professional | | $797.07 | $910.50 | $1,096.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.49 / $938.55 / $1,291.95
| Professional | | $741.49 | $938.55 | $1,291.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $743.13 / $743.13 / $743.13
| Facility | | $743.13 | $743.13 | $743.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $837.14 / $1,143.07 / $1,892.43
| Professional | | $837.14 | $1,143.07 | $1,892.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $14,418.24
| Facility | | $55.00 | $55.00 | $14,418.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,672.08 / $5,814.08 / $6,873.15
| Professional | | $5,672.08 | $5,814.08 | $6,873.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.36 / $956.71 / $1,853.54
| Facility | | $773.36 | $956.71 | $1,853.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,015.52 / $1,171.76 / $1,367.05
| Professional | | $1,015.52 | $1,171.76 | $1,367.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $744.37 / $888.05 / $1,356.25
| Professional | | $744.37 | $888.05 | $1,356.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.36 / $956.71 / $2,067.16
| Facility | | $773.36 | $956.71 | $2,067.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $837.14 / $1,160.77 / $2,067.63
| Professional | | $837.14 | $1,160.77 | $2,067.63 |
- 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
- $697.36 / $938.79 / $1,453.19
| Professional | | $697.36 | $938.79 | $1,453.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $666.71 / $765.37 / $1,044.04
| Professional | | $666.71 | $765.37 | $1,044.04 |