- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.63 / $2,822.00 / $6,075.00
| Facility | | $882.63 | $2,822.00 | $6,075.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $858.00 / $989.22 / $1,354.36
| Professional | | $858.00 | $989.22 | $1,354.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.10 / $5,047.31 / $26,542.00
| Facility | | $941.10 | $5,047.31 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,025.67 / $1,872.23 / $9,072.81
| Professional | | $1,025.67 | $1,872.23 | $9,072.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $974.02 / $1,620.25 / $1,620.25
| Professional | | $974.02 | $1,620.25 | $1,620.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $956.00 / $1,051.59 / $3,103.98
| Facility | | $956.00 | $1,051.59 | $3,103.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $739.60 / $1,549.06 / $3,010.48
| Professional | | $739.60 | $1,549.06 | $3,010.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.00 / $1,909.00 / $6,679.00
| Facility | | $814.00 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,100.88 / $1,397.88 / $2,043.46
| Professional | | $1,100.88 | $1,397.88 | $2,043.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,193.57 / $2,356.11 / $3,042.41
| Professional | | $1,193.57 | $2,356.11 | $3,042.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $6,261.43 / $26,542.00
| Facility | | $1,591.00 | $6,261.43 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,061.40 / $1,938.86 / $9,072.81
| Professional | | $1,061.40 | $1,938.86 | $9,072.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $4,006.00 / $10,764.00
| Facility | | $1,591.00 | $4,006.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,025.67 / $1,473.50 / $3,380.76
| Professional | | $1,025.67 | $1,473.50 | $3,380.76 |