- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $871.10 / $3,839.00 / $8,247.00
| Facility | | $871.10 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $717.18 / $822.93 / $1,086.75
| Professional | | $717.18 | $822.93 | $1,086.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,531.00 / $27,840.00 / $46,480.74
| Facility | | $13,531.00 | $27,840.00 | $46,480.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $810.49 / $841.07 / $841.07
| Professional | | $810.49 | $841.07 | $841.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $790.28 / $1,083.45 / $1,684.87
| Professional | | $790.28 | $1,083.45 | $1,684.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $976.82 / $1,307.80 / $1,307.80
| Professional | | $976.82 | $1,307.80 | $1,307.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.00 / $4,761.00 / $8,247.00
| Facility | | $832.00 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $717.18 / $839.06 / $2,843.00
| Professional | | $717.18 | $839.06 | $2,843.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.00 / $1,219.40 / $2,036.20
| Professional | | $17.00 | $1,219.40 | $2,036.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $838.18 / $1,100.89 / $1,819.95
| Professional | | $838.18 | $1,100.89 | $1,819.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $792.01 / $792.01 / $1,001.64
| Facility | | $792.01 | $792.01 | $1,001.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.91 / $803.83 / $1,001.64
| Professional | | $759.91 | $803.83 | $1,001.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.00 / $2,391.00 / $6,322.00
| Facility | | $625.00 | $2,391.00 | $6,322.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $705.30 / $1,014.56 / $1,660.76
| Professional | | $705.30 | $1,014.56 | $1,660.76 |