- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $897.21 / $3,745.00 / $8,017.00
| Facility | | $897.21 | $3,745.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.39 / $847.65 / $1,066.98
| Professional | | $745.39 | $847.65 | $1,066.98 |
- 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
- $839.45 / $871.12 / $871.12
| Professional | | $839.45 | $871.12 | $871.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $797.22 / $1,085.08 / $1,706.39
| Professional | | $797.22 | $1,085.08 | $1,706.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $976.85 / $1,292.15 / $1,297.60
| Professional | | $976.85 | $1,292.15 | $1,297.60 |
- 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
- $745.39 / $897.21 / $3,494.00
| Professional | | $745.39 | $897.21 | $3,494.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $1,115.59 / $2,085.60
| Professional | | $3.00 | $1,115.59 | $2,085.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $810.34 / $1,095.17 / $1,772.96
| Professional | | $810.34 | $1,095.17 | $1,772.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.27 / $816.27 / $1,061.63
| Facility | | $816.27 | $816.27 | $1,061.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $791.57 / $820.23 / $1,061.63
| Professional | | $791.57 | $820.23 | $1,061.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $3,475.00 / $6,000.00
| Facility | | $2,155.00 | $3,475.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $815.07 / $1,036.35 / $1,716.59
| Professional | | $815.07 | $1,036.35 | $1,716.59 |