- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.13 / $3,219.00 / $10,893.00
| Facility | | $791.13 | $3,219.00 | $10,893.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.88 / $836.41 / $1,324.46
| Professional | | $673.88 | $836.41 | $1,324.46 |
- 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
- $817.14 / $1,011.73 / $1,499.05
| Professional | | $817.14 | $1,011.73 | $1,499.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.03 / $791.03 / $801.94
| Facility | | $791.03 | $791.03 | $801.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $822.09 / $1,051.78 / $1,591.21
| Professional | | $822.09 | $1,051.78 | $1,591.21 |
- 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
- $6,470.00 / $6,587.04 / $7,647.98
| Professional | | $6,470.00 | $6,587.04 | $7,647.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.13 / $971.75 / $1,326.16
| Facility | | $791.13 | $971.75 | $1,326.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $878.21 / $1,405.14 / $1,756.42
| Professional | | $878.21 | $1,405.14 | $1,756.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.13 / $976.25 / $1,465.22
| Facility | | $791.13 | $976.25 | $1,465.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $837.48 / $1,110.54 / $1,759.10
| Professional | | $837.48 | $1,110.54 | $1,759.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,124.00 / $3,314.00 / $7,600.00
| Facility | | $1,124.00 | $3,314.00 | $7,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $696.44 / $928.59 / $1,412.39
| Professional | | $696.44 | $928.59 | $1,412.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $749.53 / $850.76 / $1,183.29
| Professional | | $749.53 | $850.76 | $1,183.29 |