- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.00 / $3,838.00 / $8,017.00
| Facility | | $832.00 | $3,838.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $818.83 / $940.17 / $1,325.01
| Professional | | $818.83 | $940.17 | $1,325.01 |
- 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
- $935.27 / $970.56 / $970.56
| Professional | | $935.27 | $970.56 | $970.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $902.45 / $1,209.79 / $1,905.55
| Professional | | $902.45 | $1,209.79 | $1,905.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,088.99 / $1,440.82 / $1,445.64
| Professional | | $1,088.99 | $1,440.82 | $1,445.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,314.29 / $13,547.74 / $19,353.96
| Facility | | $10,314.29 | $13,547.74 | $19,353.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.00 / $4,068.00 / $8,017.00
| Facility | | $954.00 | $4,068.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $821.39 / $964.59 / $3,494.00
| Professional | | $821.39 | $964.59 | $3,494.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,200.70 / $1,434.90 / $2,321.30
| Professional | | $1,200.70 | $1,434.90 | $2,321.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $918.34 / $1,219.66 / $1,980.73
| Professional | | $918.34 | $1,219.66 | $1,980.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $908.50 / $908.50 / $1,073.55
| Facility | | $908.50 | $908.50 | $1,073.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $880.90 / $913.02 / $1,073.55
| Professional | | $880.90 | $913.02 | $1,073.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $3,914.00 / $7,000.00
| Facility | | $2,332.00 | $3,914.00 | $7,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $921.27 / $1,186.41 / $1,913.59
| Professional | | $921.27 | $1,186.41 | $1,913.59 |