- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $919.73 / $3,623.00 / $7,799.00
| Facility | | $919.73 | $3,623.00 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $808.67 / $1,025.03 / $1,445.90
| Professional | | $808.67 | $1,025.03 | $1,445.90 |
- 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
- $1,042.72 / $1,466.81 / $2,023.45
| Professional | | $1,042.72 | $1,466.81 | $2,023.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $849.25 / $1,281.73 / $2,011.57
| Professional | | $849.25 | $1,281.73 | $2,011.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,428.09 / $1,898.96 / $1,909.26
| Professional | | $1,428.09 | $1,898.96 | $1,909.26 |
- 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
- $808.67 / $1,129.69 / $3,494.00
| Professional | | $808.67 | $1,129.69 | $3,494.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $1,005.90 / $3,147.50
| Professional | | $5.00 | $1,005.90 | $3,147.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $889.45 / $1,325.80 / $2,179.87
| Professional | | $889.45 | $1,325.80 | $2,179.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $850.87 / $881.81 / $1,167.98
| Facility | | $850.87 | $881.81 | $1,167.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $850.87 / $899.62 / $1,248.69
| Professional | | $850.87 | $899.62 | $1,248.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,334.00 / $2,824.00 / $5,678.00
| Facility | | $1,334.00 | $2,824.00 | $5,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $932.93 / $1,425.64 / $2,329.52
| Professional | | $932.93 | $1,425.64 | $2,329.52 |