- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $934.05 / $4,347.00 / $8,294.00
| Facility | | $934.05 | $4,347.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $733.03 / $938.54 / $1,626.96
| Professional | | $733.03 | $938.54 | $1,626.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,060.00 / $3,693.00 / $4,290.00
| Facility | | $3,060.00 | $3,693.00 | $4,290.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $778.45 / $1,049.15 / $1,475.34
| Professional | | $778.45 | $1,049.15 | $1,475.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $908.61 / $908.61 / $3,426.00
| Professional | | $908.61 | $908.61 | $3,426.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,377.39 / $1,377.39 / $1,377.39
| Facility | | $1,377.39 | $1,377.39 | $1,377.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $802.55 / $1,095.84 / $1,901.46
| Professional | | $802.55 | $1,095.84 | $1,901.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,052.09 / $1,167.63 / $1,390.04
| Professional | | $1,052.09 | $1,167.63 | $1,390.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.16 / $1,074.42 / $1,588.77
| Facility | | $789.16 | $1,074.42 | $1,588.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,256.00 / $1,429.00 / $2,000.00
| Professional | | $1,256.00 | $1,429.00 | $2,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.17 / $1,110.68 / $3,440.00
| Facility | | $821.17 | $1,110.68 | $3,440.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $963.45 / $1,290.14 / $3,440.00
| Professional | | $963.45 | $1,290.14 | $3,440.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,911.00 / $3,175.00 / $5,340.00
| Facility | | $1,911.00 | $3,175.00 | $5,340.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $777.04 / $1,053.01 / $1,771.58
| Professional | | $777.04 | $1,053.01 | $1,771.58 |