- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.11 / $3,627.00 / $8,017.00
| Facility | | $860.11 | $3,627.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $743.98 / $860.11 / $1,578.24
| Professional | | $743.98 | $860.11 | $1,578.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.35 / $6,182.00 / $17,094.48
| Facility | | $5,058.35 | $6,182.00 | $17,094.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $904.15 / $938.27 / $2,202.55
| Professional | | $904.15 | $938.27 | $2,202.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $895.62 / $1,187.16 / $1,825.01
| Professional | | $895.62 | $1,187.16 | $1,825.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $900.00 / $1,486.15 / $1,850.00
| Professional | | $900.00 | $1,486.15 | $1,850.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.11 / $3,839.00 / $8,017.00
| Facility | | $860.11 | $3,839.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $743.98 / $986.86 / $3,772.00
| Professional | | $743.98 | $986.86 | $3,772.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $1,120.00 / $2,226.80
| Professional | | $5.00 | $1,120.00 | $2,226.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $895.62 / $1,190.55 / $2,015.06
| Professional | | $895.62 | $1,190.55 | $2,015.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $889.58 / $889.58 / $1,677.00
| Facility | | $889.58 | $889.58 | $1,677.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $845.71 / $910.74 / $1,677.00
| Professional | | $845.71 | $910.74 | $1,677.00 |
- 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
- $929.73 / $1,160.22 / $1,853.04
| Professional | | $929.73 | $1,160.22 | $1,853.04 |