- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $3,627.00 / $7,629.00
| Facility | | $741.31 | $3,627.00 | $7,629.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.45 / $1,163.24 / $1,709.30
| Professional | | $306.45 | $1,163.24 | $1,709.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,431.95 / $7,827.00 / $19,139.18
| Facility | | $6,431.95 | $7,827.00 | $19,139.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $716.64 / $1,531.77 / $2,145.96
| Professional | | $716.64 | $1,531.77 | $2,145.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.13 / $690.30 / $2,135.88
| Professional | | $335.13 | $690.30 | $2,135.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,873.30 / $1,873.30 / $1,924.31
| Professional | | $1,873.30 | $1,873.30 | $1,924.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,775.26 / $6,775.26 / $14,536.54
| Facility | | $6,775.26 | $6,775.26 | $14,536.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $749.00 / $3,839.00 / $7,799.00
| Facility | | $749.00 | $3,839.00 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.05 / $1,163.24 / $2,154.56
| Professional | | $326.05 | $1,163.24 | $2,154.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $1,989.30 / $3,642.00
| Professional | | $4.00 | $1,989.30 | $3,642.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.10 / $707.57 / $2,062.37
| Professional | | $344.10 | $707.57 | $2,062.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.76 / $982.81 / $4,188.55
| Facility | | $302.76 | $982.81 | $4,188.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.76 / $982.81 / $1,322.33
| Professional | | $302.76 | $982.81 | $1,322.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,440.00 / $3,475.00 / $6,000.00
| Facility | | $1,440.00 | $3,475.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,189.13 / $1,649.73 / $2,545.27
| Professional | | $1,189.13 | $1,649.73 | $2,545.27 |