- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.21 / $3,839.00 / $8,247.00
| Facility | | $977.21 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $804.90 / $923.97 / $1,219.86
| Professional | | $804.90 | $923.97 | $1,219.86 |
- 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
- $802.54 / $944.16 / $944.16
| Professional | | $802.54 | $944.16 | $944.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $878.98 / $1,185.93 / $1,884.29
| Professional | | $878.98 | $1,185.93 | $1,884.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.10 / $1,467.75 / $1,467.75
| Professional | | $1,096.10 | $1,467.75 | $1,467.75 |
- 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
- $804.90 / $977.21 / $2,369.78
| Professional | | $804.90 | $977.21 | $2,369.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $1,278.30 / $2,282.19
| Professional | | $15.00 | $1,278.30 | $2,282.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $886.69 / $1,187.94 / $1,951.86
| Professional | | $886.69 | $1,187.94 | $1,951.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $888.82 / $888.82 / $1,035.80
| Facility | | $888.82 | $888.82 | $1,035.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $852.61 / $902.29 / $1,035.80
| Professional | | $852.61 | $902.29 | $1,035.80 |
- 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
- $799.96 / $1,115.83 / $1,858.03
| Professional | | $799.96 | $1,115.83 | $1,858.03 |