- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $949.44 / $3,596.00 / $10,836.00
| Facility | | $949.44 | $3,596.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $952.86 / $1,035.31 / $1,432.11
| Professional | | $952.86 | $1,035.31 | $1,432.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $883.47 / $925.67 / $1,067.57
| Professional | | $883.47 | $925.67 | $1,067.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $867.61 / $867.61 / $867.61
| Facility | | $867.61 | $867.61 | $867.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,003.35 / $1,329.49 / $2,062.39
| Professional | | $1,003.35 | $1,329.49 | $2,062.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $8,946.16
| Facility | | $55.00 | $55.00 | $8,946.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,144.08 / $7,304.24 / $8,148.30
| Professional | | $7,144.08 | $7,304.24 | $8,148.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $968.43 / $1,286.88 / $2,172.13
| Facility | | $968.43 | $1,286.88 | $2,172.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.85 / $1,457.48 / $1,714.68
| Professional | | $1,047.85 | $1,457.48 | $1,714.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,419.20 / $1,419.20 / $1,419.20
| Professional | | $1,419.20 | $1,419.20 | $1,419.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $968.43 / $1,298.61 / $2,329.44
| Facility | | $968.43 | $1,298.61 | $2,329.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,003.35 / $1,352.03 / $2,238.12
| Professional | | $1,003.35 | $1,352.03 | $2,238.12 |
- 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
- $828.34 / $1,125.45 / $1,739.34
| Professional | | $828.34 | $1,125.45 | $1,739.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $813.02 / $931.15 / $1,285.98
| Professional | | $813.02 | $931.15 | $1,285.98 |