- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $892.54 / $2,747.00 / $8,017.00
| Facility | | $892.54 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $733.10 / $842.68 / $1,102.75
| Professional | | $733.10 | $842.68 | $1,102.75 |
- 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
- $826.60 / $857.79 / $1,278.26
| Professional | | $826.60 | $857.79 | $1,278.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $764.83 / $1,051.70 / $1,681.26
| Professional | | $764.83 | $1,051.70 | $1,681.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $982.65 / $1,303.50 / $1,311.55
| Professional | | $982.65 | $1,303.50 | $1,311.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,495.40 / $12,495.40 / $12,495.40
| Facility | | $12,495.40 | $12,495.40 | $12,495.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $934.00 / $3,120.00 / $8,017.00
| Facility | | $934.00 | $3,120.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $772.18 / $934.00 / $2,650.84
| Professional | | $772.18 | $934.00 | $2,650.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $1,152.00 / $2,148.50
| Professional | | $6.00 | $1,152.00 | $2,148.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $801.88 / $1,068.60 / $1,722.19
| Professional | | $801.88 | $1,068.60 | $1,722.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.47 / $816.47 / $937.70
| Facility | | $816.47 | $816.47 | $937.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $795.31 / $816.55 / $937.70
| Professional | | $795.31 | $816.55 | $937.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,468.00 / $6,885.00 / $19,040.18
| Facility | | $2,468.00 | $6,885.00 | $19,040.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $705.08 / $1,004.08 / $1,624.73
| Professional | | $705.08 | $1,004.08 | $1,624.73 |