- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $857.53 / $3,745.00 / $8,017.00
| Facility | | $857.53 | $3,745.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.16 / $818.63 / $1,158.99
| Professional | | $776.16 | $818.63 | $1,158.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,800.00 / $5,951.00 / $8,887.00
| Facility | | $2,800.00 | $5,951.00 | $8,887.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $945.02 / $980.68 / $980.68
| Professional | | $945.02 | $980.68 | $980.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $757.80 / $1,008.70 / $1,838.42
| Professional | | $757.80 | $1,008.70 | $1,838.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,134.16 / $1,458.20 / $1,508.84
| Professional | | $1,134.16 | $1,458.20 | $1,508.84 |
- 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
- $803.14 / $909.06 / $4,804.60
| Professional | | $803.14 | $909.06 | $4,804.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $965.30 / $965.30 / $1,014.20
| Professional | | $965.30 | $965.30 | $1,014.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,069.83 / $1,069.83 / $1,069.83
| Facility | | $1,069.83 | $1,069.83 | $1,069.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $830.50 / $1,020.57 / $1,884.52
| Professional | | $830.50 | $1,020.57 | $1,884.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.60 / $914.03 / $914.03
| Facility | | $818.60 | $914.03 | $914.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $818.60 / $914.03 / $970.45
| Professional | | $818.60 | $914.03 | $970.45 |
- 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
- $785.37 / $980.68 / $1,753.16
| Professional | | $785.37 | $980.68 | $1,753.16 |