- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $885.11 / $4,264.00 / $8,240.00
| Facility | | $885.11 | $4,264.00 | $8,240.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.61 / $831.36 / $1,079.81
| Professional | | $675.61 | $831.36 | $1,079.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.91 / $11,851.00 / $28,970.26
| Facility | | $8,639.91 | $11,851.00 | $28,970.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $801.39 / $831.63 / $831.63
| Professional | | $801.39 | $831.63 | $831.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $740.25 / $1,011.76 / $1,667.25
| Professional | | $740.25 | $1,011.76 | $1,667.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $957.51 / $1,270.34 / $1,282.71
| Professional | | $957.51 | $1,270.34 | $1,282.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $4,761.00 / $8,247.00
| Facility | | $1,013.00 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $700.00 / $869.00 / $4,178.07
| Professional | | $700.00 | $869.00 | $4,178.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $909.30 / $2,145.19
| Professional | | $7.00 | $909.30 | $2,145.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $784.51 / $1,024.22 / $1,689.52
| Professional | | $784.51 | $1,024.22 | $1,689.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $801.70 / $801.70 / $926.76
| Facility | | $801.70 | $801.70 | $926.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $782.91 / $801.70 / $926.76
| Professional | | $782.91 | $801.70 | $926.76 |
- 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
- $670.16 / $974.64 / $1,578.02
| Professional | | $670.16 | $974.64 | $1,578.02 |