- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $824.42 / $3,627.00 / $8,017.00
| Facility | | $824.42 | $3,627.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $788.88 / $1,240.40 / $2,385.69
| Professional | | $788.88 | $1,240.40 | $2,385.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,431.95 / $7,827.00 / $19,139.18
| Facility | | $6,431.95 | $7,827.00 | $19,139.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,369.27 / $2,367.37 / $2,762.78
| Professional | | $1,369.27 | $2,367.37 | $2,762.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $860.43 / $1,356.34 / $2,389.15
| Professional | | $860.43 | $1,356.34 | $2,389.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,643.22 / $2,112.71 / $2,176.26
| Professional | | $1,643.22 | $2,112.71 | $2,176.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.50 / $3,866.46 / $12,346.50
| Facility | | $0.50 | $3,866.46 | $12,346.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.00 / $3,964.00 / $8,017.00
| Facility | | $954.00 | $3,964.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $815.66 / $1,321.52 / $3,748.00
| Professional | | $815.66 | $1,321.52 | $3,748.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,534.91 / $1,534.91 / $1,534.91
| Facility | | $1,534.91 | $1,534.91 | $1,534.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $897.62 / $1,382.54 / $2,491.35
| Professional | | $897.62 | $1,382.54 | $2,491.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $889.25 / $1,015.12 / $1,675.62
| Facility | | $889.25 | $1,015.12 | $1,675.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $888.60 / $1,356.44 / $1,480.22
| Professional | | $888.60 | $1,356.44 | $1,480.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $3,475.00 / $6,368.00
| Facility | | $2,155.00 | $3,475.00 | $6,368.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,336.10 / $1,658.07 / $2,923.18
| Professional | | $1,336.10 | $1,658.07 | $2,923.18 |