- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $952.69 / $3,066.00 / $7,799.00
| Facility | | $952.69 | $3,066.00 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $824.14 / $918.34 / $1,348.83
| Professional | | $824.14 | $918.34 | $1,348.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.91 / $11,851.00 / $26,582.19
| Facility | | $8,639.91 | $11,851.00 | $26,582.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $922.42 / $957.23 / $1,679.11
| Professional | | $922.42 | $957.23 | $1,679.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $949.24 / $2,304.46 / $2,902.05
| Professional | | $949.24 | $2,304.46 | $2,902.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,091.05 / $1,478.96 / $1,884.53
| Professional | | $1,091.05 | $1,478.96 | $1,884.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.00 / $3,839.00 / $8,017.00
| Facility | | $954.00 | $3,839.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $824.14 / $1,028.45 / $4,531.74
| Professional | | $824.14 | $1,028.45 | $4,531.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,041.50 / $1,041.50 / $1,882.80
| Professional | | $1,041.50 | $1,041.50 | $1,882.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $949.24 / $2,304.46 / $2,902.05
| Professional | | $949.24 | $2,304.46 | $2,902.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $867.16 / $896.19 / $896.19
| Facility | | $867.16 | $896.19 | $896.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $867.16 / $896.19 / $950.11
| Professional | | $867.16 | $896.19 | $950.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,843.00 / $3,742.00 / $7,000.00
| Facility | | $1,843.00 | $3,742.00 | $7,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $853.99 / $1,136.56 / $1,730.29
| Professional | | $853.99 | $1,136.56 | $1,730.29 |