- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,618.00 / $4,712.00
| Facility | | $933.25 | $2,618.00 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $566.95 / $653.41 / $1,618.40
| Professional | | $566.95 | $653.41 | $1,618.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,442.08 / $4,402.00 / $9,401.00
| Facility | | $1,442.08 | $4,402.00 | $9,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $619.04 / $1,073.21 / $5,110.16
| Professional | | $619.04 | $1,073.21 | $5,110.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $920.40 / $1,257.80 / $1,703.89
| Professional | | $920.40 | $1,257.80 | $1,703.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $642.86 / $1,004.85 / $1,832.39
| Professional | | $642.86 | $1,004.85 | $1,832.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.66 / $1,398.54 / $6,679.00
| Facility | | $645.66 | $1,398.54 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $740.91 / $897.48 / $1,230.72
| Professional | | $740.91 | $897.48 | $1,230.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $802.82 / $1,591.51 / $2,099.44
| Professional | | $802.82 | $1,591.51 | $2,099.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,680.41 / $7,680.41 / $7,680.41
| Facility | | $7,680.41 | $7,680.41 | $7,680.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,656.30 / $4,656.30 / $4,656.30
| Professional | | $4,656.30 | $4,656.30 | $4,656.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,268.00 / $26,542.00
| Facility | | $2,155.00 | $5,268.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $669.20 / $1,183.30 / $5,110.16
| Professional | | $669.20 | $1,183.30 | $5,110.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,983.00 / $8,810.00
| Facility | | $2,155.00 | $4,983.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $662.24 / $990.83 / $1,885.85
| Professional | | $662.24 | $990.83 | $1,885.85 |