- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $628.28 / $1,000.40 / $1,784.36
| Professional | | $628.28 | $1,000.40 | $1,784.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.73 / $127.12 / $127.12
| Facility | | $114.73 | $127.12 | $127.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $983.20 / $1,271.24 / $2,289.69
| Professional | | $983.20 | $1,271.24 | $2,289.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,710.71 / $2,710.71 / $2,710.71
| Facility | | $2,710.71 | $2,710.71 | $2,710.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $1,327.02 / $1,327.02
| Professional | | $100.00 | $1,327.02 | $1,327.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $975.26 / $975.26 / $1,567.57
| Facility | | $975.26 | $975.26 | $1,567.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $828.97 / $975.26 / $2,655.00
| Professional | | $828.97 | $975.26 | $2,655.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,638.73 / $1,638.73 / $1,966.48
| Professional | | $1,638.73 | $1,638.73 | $1,966.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.07 / $1,584.18 / $1,979.00
| Professional | | $638.07 | $1,584.18 | $1,979.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,644.91 / $10,273.09 / $10,647.60
| Facility | | $1,644.91 | $10,273.09 | $10,647.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.97 / $1,114.33 / $2,462.39
| Facility | | $228.97 | $1,114.33 | $2,462.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.80 / $975.26 / $1,004.52
| Professional | | $626.80 | $975.26 | $1,004.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,638.73 / $1,638.73 / $1,638.73
| Professional | | $1,638.73 | $1,638.73 | $1,638.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $772.80 / $963.59 / $1,792.02
| Professional | | $772.80 | $963.59 | $1,792.02 |