- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $805.31 / $2,747.00 / $8,017.00
| Facility | | $805.31 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.12 / $756.31 / $1,050.48
| Professional | | $655.12 | $756.31 | $1,050.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,736.00 / $4,444.00 / $15,949.31
| Facility | | $3,736.00 | $4,444.00 | $15,949.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $861.53 / $894.04 / $1,529.44
| Professional | | $861.53 | $894.04 | $1,529.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $690.84 / $873.17 / $1,554.57
| Professional | | $690.84 | $873.17 | $1,554.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,027.10 / $1,320.57 / $1,362.14
| Professional | | $1,027.10 | $1,320.57 | $1,362.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $918.00 / $3,120.00 / $8,017.00
| Facility | | $918.00 | $3,120.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.50 / $805.31 / $3,980.51
| Professional | | $655.50 | $805.31 | $3,980.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,278.85 / $1,278.85 / $1,278.85
| Facility | | $1,278.85 | $1,278.85 | $1,278.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $709.87 / $890.38 / $1,629.44
| Professional | | $709.87 | $890.38 | $1,629.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $706.92 / $739.96 / $856.63
| Facility | | $706.92 | $739.96 | $856.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.17 / $791.10 / $910.78
| Professional | | $719.17 | $791.10 | $910.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,440.00 / $3,475.00 / $6,368.00
| Facility | | $1,440.00 | $3,475.00 | $6,368.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $744.30 / $959.35 / $1,682.65
| Professional | | $744.30 | $959.35 | $1,682.65 |