- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $925.70 / $3,596.00 / $10,836.00
| Facility | | $925.70 | $3,596.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.03 / $1,003.70 / $1,387.36
| Professional | | $912.03 | $1,003.70 | $1,387.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $884.00 / $1,118.93 / $1,558.92
| Professional | | $884.00 | $1,118.93 | $1,558.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.30 / $912.30 / $912.30
| Facility | | $912.30 | $912.30 | $912.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $976.04 / $1,267.24 / $1,971.35
| Professional | | $976.04 | $1,267.24 | $1,971.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $8,765.28
| Facility | | $55.00 | $55.00 | $8,765.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,427.52 / $7,672.63 / $8,357.18
| Professional | | $7,427.52 | $7,672.63 | $8,357.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $920.90 / $1,173.03 / $2,098.78
| Facility | | $920.90 | $1,173.03 | $2,098.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,041.10 / $1,448.08 / $1,703.63
| Professional | | $1,041.10 | $1,448.08 | $1,703.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.70 / $1,230.70 / $1,230.70
| Professional | | $1,230.70 | $1,230.70 | $1,230.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $920.82 / $1,221.19 / $2,211.21
| Facility | | $920.82 | $1,221.19 | $2,211.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $983.40 / $1,285.35 / $1,982.53
| Professional | | $983.40 | $1,285.35 | $1,982.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.00 / $2,546.00 / $9,000.00
| Facility | | $495.00 | $2,546.00 | $9,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $756.36 / $1,045.11 / $1,692.10
| Professional | | $756.36 | $1,045.11 | $1,692.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $807.78 / $918.11 / $1,268.84
| Professional | | $807.78 | $918.11 | $1,268.84 |