- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.00 / $3,748.00 / $8,017.00
| Facility | | $832.00 | $3,748.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $832.51 / $981.21 / $1,526.64
| Professional | | $832.51 | $981.21 | $1,526.64 |
- 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
- $943.33 / $978.92 / $978.92
| Professional | | $943.33 | $978.92 | $978.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $910.26 / $1,222.25 / $2,005.20
| Professional | | $910.26 | $1,222.25 | $2,005.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,098.25 / $1,453.05 / $1,457.83
| Professional | | $1,098.25 | $1,453.05 | $1,457.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,500.74 / $10,500.74 / $15,794.93
| Facility | | $10,500.74 | $10,500.74 | $15,794.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.00 / $3,964.00 / $8,017.00
| Facility | | $954.00 | $3,964.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $864.85 / $1,063.81 / $2,928.32
| Professional | | $864.85 | $1,063.81 | $2,928.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $1,403.50 / $1,968.10
| Professional | | $3.00 | $1,403.50 | $1,968.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $934.43 / $1,230.22 / $2,083.82
| Professional | | $934.43 | $1,230.22 | $2,083.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $916.15 / $916.15 / $1,319.18
| Facility | | $916.15 | $916.15 | $1,319.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $888.58 / $920.68 / $1,319.18
| Professional | | $888.58 | $920.68 | $1,319.18 |
- 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
- $939.54 / $1,219.20 / $1,959.87
| Professional | | $939.54 | $1,219.20 | $1,959.87 |