- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.40 / $3,745.00 / $8,017.00
| Facility | | $816.40 | $3,745.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.77 / $795.81 / $1,438.00
| Professional | | $741.77 | $795.81 | $1,438.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.35 / $6,182.00 / $17,094.48
| Facility | | $5,058.35 | $6,182.00 | $17,094.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $893.25 / $926.96 / $1,616.39
| Professional | | $893.25 | $926.96 | $1,616.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $721.37 / $947.45 / $1,663.12
| Professional | | $721.37 | $947.45 | $1,663.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,070.72 / $1,376.64 / $1,424.71
| Professional | | $1,070.72 | $1,376.64 | $1,424.71 |
- 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
- $773.52 / $914.75 / $4,694.20
| Professional | | $773.52 | $914.75 | $4,694.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $814.20 / $814.20 / $852.30
| Professional | | $814.20 | $814.20 | $852.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,009.94 / $1,009.94 / $1,009.94
| Facility | | $1,009.94 | $1,009.94 | $1,009.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $780.81 / $970.23 / $1,794.14
| Professional | | $780.81 | $970.23 | $1,794.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.74 / $870.74 / $871.01
| Facility | | $870.74 | $870.74 | $871.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.74 / $871.01 / $923.29
| Professional | | $870.74 | $871.01 | $923.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.00 / $2,884.00 / $6,000.00
| Facility | | $1,122.00 | $2,884.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $746.38 / $960.37 / $1,684.56
| Professional | | $746.38 | $960.37 | $1,684.56 |