- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $896.55 / $3,596.00 / $10,836.00
| Facility | | $896.55 | $3,596.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $876.50 / $974.01 / $1,344.82
| Professional | | $876.50 | $974.01 | $1,344.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $840.91 / $1,064.39 / $1,482.93
| Professional | | $840.91 | $1,064.39 | $1,482.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.05 / $818.05 / $818.05
| Facility | | $818.05 | $818.05 | $818.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $943.15 / $1,242.96 / $1,922.05
| Professional | | $943.15 | $1,242.96 | $1,922.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $7,360.36
| Facility | | $55.00 | $55.00 | $7,360.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,413.45 / $7,413.45 / $7,665.98
| Professional | | $7,413.45 | $7,413.45 | $7,665.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $910.59 / $1,186.16 / $2,114.28
| Facility | | $910.59 | $1,186.16 | $2,114.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $985.24 / $1,370.38 / $1,612.21
| Professional | | $985.24 | $1,370.38 | $1,612.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,396.50 / $1,396.50 / $1,396.50
| Professional | | $1,396.50 | $1,396.50 | $1,396.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $910.59 / $1,186.16 / $2,344.33
| Facility | | $910.59 | $1,186.16 | $2,344.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $943.15 / $1,259.79 / $2,099.19
| Professional | | $943.15 | $1,259.79 | $2,099.19 |
- 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
- $772.32 / $1,061.94 / $1,641.18
| Professional | | $772.32 | $1,061.94 | $1,641.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $764.43 / $874.90 / $1,209.25
| Professional | | $764.43 | $874.90 | $1,209.25 |