- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $886.65 / $3,570.00 / $10,836.00
| Facility | | $886.65 | $3,570.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.58 / $992.55 / $1,421.33
| Professional | | $870.58 | $992.55 | $1,421.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $806.74 / $1,025.07 / $1,422.68
| Professional | | $806.74 | $1,025.07 | $1,422.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.11 / $851.11 / $851.11
| Facility | | $851.11 | $851.11 | $851.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $918.44 / $1,217.92 / $1,936.97
| Professional | | $918.44 | $1,217.92 | $1,936.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $15,861.12
| Facility | | $55.00 | $55.00 | $15,861.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,232.16 / $6,367.04 / $7,531.05
| Professional | | $6,232.16 | $6,367.04 | $7,531.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $909.63 / $1,123.88 / $1,976.54
| Facility | | $909.63 | $1,123.88 | $1,976.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,113.50 / $1,284.81 / $1,498.95
| Professional | | $1,113.50 | $1,284.81 | $1,498.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $839.57 / $917.77 / $1,482.12
| Professional | | $839.57 | $917.77 | $1,482.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $909.63 / $1,131.53 / $2,249.08
| Facility | | $909.63 | $1,131.53 | $2,249.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $918.44 / $1,226.04 / $2,029.79
| Professional | | $918.44 | $1,226.04 | $2,029.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.00 / $2,546.00 / $9,187.00
| Facility | | $448.00 | $2,546.00 | $9,187.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $736.85 / $973.88 / $1,557.78
| Professional | | $736.85 | $973.88 | $1,557.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $731.03 / $834.94 / $1,147.51
| Professional | | $731.03 | $834.94 | $1,147.51 |