- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $839.23 / $3,745.00 / $8,017.00
| Facility | | $839.23 | $3,745.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.47 / $815.59 / $1,126.40
| Professional | | $758.47 | $815.59 | $1,126.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,736.00 / $4,444.00 / $15,949.31
| Facility | | $3,736.00 | $4,444.00 | $15,949.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $915.21 / $949.75 / $1,545.29
| Professional | | $915.21 | $949.75 | $1,545.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $728.81 / $987.62 / $1,708.34
| Professional | | $728.81 | $987.62 | $1,708.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,097.17 / $1,410.64 / $1,459.63
| Professional | | $1,097.17 | $1,410.64 | $1,459.63 |
- 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
- $794.61 / $895.10 / $4,803.66
| Professional | | $794.61 | $895.10 | $4,803.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $882.90 / $882.90 / $925.30
| Professional | | $882.90 | $882.90 | $925.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,035.23 / $1,035.23 / $1,035.23
| Facility | | $1,035.23 | $1,035.23 | $1,035.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $773.55 / $996.59 / $1,844.32
| Professional | | $773.55 | $996.59 | $1,844.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $790.36 / $894.42 / $894.42
| Facility | | $790.36 | $894.42 | $894.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $790.36 / $894.42 / $948.96
| Professional | | $790.36 | $894.42 | $948.96 |
- 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
- $770.89 / $965.46 / $1,721.92
| Professional | | $770.89 | $965.46 | $1,721.92 |