- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $939.80 / $3,669.00 / $12,040.00
| Facility | | $939.80 | $3,669.00 | $12,040.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $844.68 / $939.80 / $1,311.02
| Professional | | $844.68 | $939.80 | $1,311.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $803.07 / $1,023.48 / $1,425.94
| Professional | | $803.07 | $1,023.48 | $1,425.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $788.43 / $788.43 / $788.43
| Facility | | $788.43 | $788.43 | $788.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $911.40 / $1,200.02 / $1,855.72
| Professional | | $911.40 | $1,200.02 | $1,855.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $7,109.27
| Facility | | $55.00 | $55.00 | $7,109.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,487.76 / $6,633.76 / $7,402.58
| Professional | | $6,487.76 | $6,633.76 | $7,402.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $879.16 / $1,168.05 / $1,973.49
| Facility | | $879.16 | $1,168.05 | $1,973.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $951.80 / $1,323.86 / $1,557.49
| Professional | | $951.80 | $1,323.86 | $1,557.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,336.40 / $1,336.40 / $1,336.40
| Professional | | $1,336.40 | $1,336.40 | $1,336.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $879.16 / $1,180.56 / $2,254.23
| Facility | | $879.16 | $1,180.56 | $2,254.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $911.40 / $1,218.33 / $2,018.13
| Professional | | $911.40 | $1,218.33 | $2,018.13 |
- 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
- $744.02 / $1,023.03 / $1,581.05
| Professional | | $744.02 | $1,023.03 | $1,581.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $738.48 / $845.82 / $1,167.99
| Professional | | $738.48 | $845.82 | $1,167.99 |