- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $934.17 / $4,304.00 / $8,240.00
| Facility | | $934.17 | $4,304.00 | $8,240.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $847.44 / $893.42 / $1,418.88
| Professional | | $847.44 | $893.42 | $1,418.88 |
- 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
- $1,017.97 / $1,056.39 / $1,056.39
| Professional | | $1,017.97 | $1,056.39 | $1,056.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $845.81 / $1,099.20 / $1,972.07
| Professional | | $845.81 | $1,099.20 | $1,972.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,220.10 / $1,568.71 / $1,623.18
| Professional | | $1,220.10 | $1,568.71 | $1,623.18 |
- 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
- $870.21 / $1,012.45 / $5,348.92
| Professional | | $870.21 | $1,012.45 | $5,348.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,077.00 / $1,077.00 / $1,131.70
| Professional | | $1,077.00 | $1,077.00 | $1,131.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.29 / $1,151.29 / $1,151.29
| Facility | | $1,151.29 | $1,151.29 | $1,151.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $895.60 / $1,108.91 / $2,045.86
| Professional | | $895.60 | $1,108.91 | $2,045.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $995.16 / $995.16 / $1,032.91
| Facility | | $995.16 | $995.16 | $1,032.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $995.16 / $998.15 / $1,055.68
| Professional | | $995.16 | $998.15 | $1,055.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.00 / $2,391.00 / $6,000.00
| Facility | | $637.00 | $2,391.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $860.23 / $1,075.28 / $1,964.36
| Professional | | $860.23 | $1,075.28 | $1,964.36 |