- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $970.09 / $4,304.00 / $8,240.00
| Facility | | $970.09 | $4,304.00 | $8,240.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $855.91 / $927.67 / $1,300.86
| Professional | | $855.91 | $927.67 | $1,300.86 |
- 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
- $1,060.71 / $1,100.74 / $1,100.74
| Professional | | $1,060.71 | $1,100.74 | $1,100.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $835.09 / $1,100.73 / $1,974.34
| Professional | | $835.09 | $1,100.73 | $1,974.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,271.80 / $1,635.17 / $1,692.18
| Professional | | $1,271.80 | $1,635.17 | $1,692.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $4,761.00 / $8,247.00
| Facility | | $1,013.00 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $909.13 / $1,015.59 / $5,352.85
| Professional | | $909.13 | $1,015.59 | $5,352.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,057.70 / $1,057.70 / $1,112.70
| Professional | | $1,057.70 | $1,057.70 | $1,112.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,199.65 / $1,199.65 / $1,199.65
| Facility | | $1,199.65 | $1,199.65 | $1,199.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $841.63 / $1,150.77 / $2,109.11
| Professional | | $841.63 | $1,150.77 | $2,109.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,033.69 / $1,033.69 / $1,045.25
| Facility | | $1,033.69 | $1,033.69 | $1,045.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,033.69 / $1,036.73 / $1,096.42
| Professional | | $1,033.69 | $1,036.73 | $1,096.42 |
- 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
- $779.41 / $1,064.22 / $2,001.09
| Professional | | $779.41 | $1,064.22 | $2,001.09 |