- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $978.41 / $2,747.00 / $8,017.00
| Facility | | $978.41 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $828.43 / $925.68 / $1,547.33
| Professional | | $828.43 | $925.68 | $1,547.33 |
- 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
- $966.18 / $1,002.64 / $1,768.64
| Professional | | $966.18 | $1,002.64 | $1,768.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,090.33 / $1,090.33 / $1,090.33
| Facility | | $1,090.33 | $1,090.33 | $1,090.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $830.30 / $1,154.10 / $1,893.52
| Professional | | $830.30 | $1,154.10 | $1,893.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,139.75 / $1,546.39 / $1,968.67
| Professional | | $1,139.75 | $1,546.39 | $1,968.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $978.41 / $3,077.00 / $8,017.00
| Facility | | $978.41 | $3,077.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $832.99 / $1,096.21 / $2,905.87
| Professional | | $832.99 | $1,096.21 | $2,905.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,045.80 / $1,045.80 / $1,958.40
| Professional | | $1,045.80 | $1,045.80 | $1,958.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,090.33 / $1,090.33 / $1,090.33
| Facility | | $1,090.33 | $1,090.33 | $1,090.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.74 / $1,184.93 / $1,897.16
| Professional | | $851.74 | $1,184.93 | $1,897.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.07 / $941.07 / $984.48
| Facility | | $941.07 | $941.07 | $984.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $910.30 / $947.59 / $995.61
| Professional | | $910.30 | $947.59 | $995.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $3,879.00 / $7,508.00
| Facility | | $2,332.00 | $3,879.00 | $7,508.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $902.96 / $1,182.26 / $1,816.42
| Professional | | $902.96 | $1,182.26 | $1,816.42 |