- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $856.39 / $3,745.00 / $8,017.00
| Facility | | $856.39 | $3,745.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $773.67 / $818.96 / $1,143.88
| Professional | | $773.67 | $818.96 | $1,143.88 |
- 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
- $932.70 / $967.90 / $967.90
| Professional | | $932.70 | $967.90 | $967.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.24 / $1,002.91 / $1,773.38
| Professional | | $761.24 | $1,002.91 | $1,773.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,118.78 / $1,438.43 / $1,488.48
| Professional | | $1,118.78 | $1,438.43 | $1,488.48 |
- 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
- $790.28 / $904.40 / $4,778.71
| Professional | | $790.28 | $904.40 | $4,778.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $955.70 / $955.70 / $1,003.90
| Professional | | $955.70 | $955.70 | $1,003.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,055.32 / $1,055.32 / $1,055.32
| Facility | | $1,055.32 | $1,055.32 | $1,055.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $809.88 / $1,011.89 / $1,858.13
| Professional | | $809.88 | $1,011.89 | $1,858.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $854.15 / $912.09 / $912.09
| Facility | | $854.15 | $912.09 | $912.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $854.15 / $912.09 / $968.03
| Professional | | $854.15 | $912.09 | $968.03 |
- 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
- $780.79 / $983.10 / $1,720.22
| Professional | | $780.79 | $983.10 | $1,720.22 |