- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $779.54 / $3,219.00 / $10,893.00
| Facility | | $779.54 | $3,219.00 | $10,893.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $661.74 / $814.93 / $1,252.53
| Professional | | $661.74 | $814.93 | $1,252.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,017.43 / $3,640.66 / $6,960.00
| Facility | | $2,017.43 | $3,640.66 | $6,960.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $714.94 / $950.87 / $1,425.39
| Professional | | $714.94 | $950.87 | $1,425.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $777.57 / $777.57 / $788.18
| Facility | | $777.57 | $777.57 | $788.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $815.30 / $1,034.90 / $1,561.64
| Professional | | $815.30 | $1,034.90 | $1,561.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,817.20 / $26,542.00 / $26,542.00
| Facility | | $6,817.20 | $26,542.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,353.20 / $6,470.64 / $7,504.88
| Professional | | $6,353.20 | $6,470.64 | $7,504.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.77 / $960.27 / $1,314.45
| Facility | | $776.77 | $960.27 | $1,314.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $862.03 / $1,379.25 / $1,724.06
| Professional | | $862.03 | $1,379.25 | $1,724.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.77 / $964.33 / $1,467.45
| Facility | | $776.77 | $964.33 | $1,467.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $822.23 / $1,104.78 / $1,754.00
| Professional | | $822.23 | $1,104.78 | $1,754.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,390.00 / $4,114.00 / $8,226.00
| Facility | | $1,390.00 | $4,114.00 | $8,226.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $682.91 / $910.54 / $1,384.93
| Professional | | $682.91 | $910.54 | $1,384.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $735.72 / $835.02 / $1,161.65
| Professional | | $735.72 | $835.02 | $1,161.65 |