- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $889.55 / $3,596.00 / $10,836.00
| Facility | | $889.55 | $3,596.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $798.51 / $913.23 / $1,099.13
| Professional | | $798.51 | $913.23 | $1,099.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $743.64 / $941.27 / $1,282.65
| Professional | | $743.64 | $941.27 | $1,282.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $744.21 / $744.21 / $744.21
| Facility | | $744.21 | $744.21 | $744.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $839.19 / $1,060.79 / $1,480.18
| Professional | | $839.19 | $1,060.79 | $1,480.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $18,960.06
| Facility | | $55.00 | $55.00 | $18,960.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,682.88 / $5,823.84 / $6,888.15
| Professional | | $5,682.88 | $5,823.84 | $6,888.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.57 / $968.85 / $1,858.12
| Facility | | $776.57 | $968.85 | $1,858.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,017.63 / $1,174.19 / $1,369.88
| Professional | | $1,017.63 | $1,174.19 | $1,369.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $740.21 / $808.40 / $1,344.32
| Professional | | $740.21 | $808.40 | $1,344.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.57 / $992.40 / $1,901.94
| Facility | | $776.57 | $992.40 | $1,901.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $839.19 / $1,108.65 / $1,680.00
| Professional | | $839.19 | $1,108.65 | $1,680.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.00 / $2,547.00 / $9,000.00
| Facility | | $495.00 | $2,547.00 | $9,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $696.96 / $958.32 / $1,856.26
| Professional | | $696.96 | $958.32 | $1,856.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $668.09 / $767.08 / $1,046.07
| Professional | | $668.09 | $767.08 | $1,046.07 |