- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $859.64 / $3,596.00 / $10,836.00
| Facility | | $859.64 | $3,596.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $746.50 / $855.71 / $1,028.18
| Professional | | $746.50 | $855.71 | $1,028.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $695.63 / $880.50 / $1,226.73
| Professional | | $695.63 | $880.50 | $1,226.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $697.22 / $697.22 / $697.22
| Facility | | $697.22 | $697.22 | $697.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $788.36 / $1,049.08 / $1,658.28
| Professional | | $788.36 | $1,049.08 | $1,658.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $17,761.16
| Facility | | $55.00 | $55.00 | $17,761.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,322.56 / $5,451.76 / $6,454.05
| Professional | | $5,322.56 | $5,451.76 | $6,454.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.90 / $898.04 / $1,737.40
| Facility | | $725.90 | $898.04 | $1,737.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $953.29 / $1,099.95 / $1,283.28
| Professional | | $953.29 | $1,099.95 | $1,283.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $698.19 / $832.90 / $1,272.83
| Professional | | $698.19 | $832.90 | $1,272.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.90 / $898.04 / $1,939.31
| Facility | | $725.90 | $898.04 | $1,939.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $786.01 / $1,088.47 / $1,816.54
| Professional | | $786.01 | $1,088.47 | $1,816.54 |
- 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
- $651.34 / $853.08 / $1,361.56
| Professional | | $651.34 | $853.08 | $1,361.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $625.85 / $718.43 / $979.97
| Professional | | $625.85 | $718.43 | $979.97 |