- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $848.39 / $3,839.00 / $8,247.00
| Facility | | $848.39 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $710.72 / $802.24 / $1,167.83
| Professional | | $710.72 | $802.24 | $1,167.83 |
- 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
- $789.92 / $819.73 / $819.73
| Professional | | $789.92 | $819.73 | $819.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $782.93 / $1,070.84 / $1,696.77
| Professional | | $782.93 | $1,070.84 | $1,696.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $951.28 / $1,273.76 / $1,273.76
| Professional | | $951.28 | $1,273.76 | $1,273.76 |
- 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
- $725.41 / $848.39 / $1,544.00
| Professional | | $725.41 | $848.39 | $1,544.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $1,247.09 / $1,979.90
| Professional | | $15.00 | $1,247.09 | $1,979.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $815.49 / $1,096.09 / $1,833.87
| Professional | | $815.49 | $1,096.09 | $1,833.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $772.53 / $772.53 / $989.13
| Facility | | $772.53 | $772.53 | $989.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $740.64 / $784.66 / $989.13
| Professional | | $740.64 | $784.66 | $989.13 |
- 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
- $725.49 / $968.77 / $1,605.64
| Professional | | $725.49 | $968.77 | $1,605.64 |