- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $935.93 / $3,839.00 / $8,427.00
| Facility | | $935.93 | $3,839.00 | $8,427.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.40 / $858.55 / $1,075.89
| Professional | | $761.40 | $858.55 | $1,075.89 |
- 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
- $774.79 / $804.02 / $1,309.88
| Professional | | $774.79 | $804.02 | $1,309.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $767.75 / $1,009.08 / $1,570.66
| Professional | | $767.75 | $1,009.08 | $1,570.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,201.66 / $1,201.66 / $1,243.81
| Professional | | $1,201.66 | $1,201.66 | $1,243.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $935.93 / $4,761.00 / $8,427.00
| Facility | | $935.93 | $4,761.00 | $8,427.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.59 / $935.93 / $4,009.10
| Professional | | $724.59 | $935.93 | $4,009.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $1,252.09 / $1,952.20
| Professional | | $15.00 | $1,252.09 | $1,952.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $782.82 / $1,021.98 / $1,570.66
| Professional | | $782.82 | $1,021.98 | $1,570.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $757.57 / $757.57 / $757.57
| Facility | | $757.57 | $757.57 | $757.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $728.02 / $757.57 / $797.59
| Professional | | $728.02 | $757.57 | $797.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.00 / $2,391.00 / $6,322.00
| Facility | | $656.00 | $2,391.00 | $6,322.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $721.66 / $970.45 / $1,567.40
| Professional | | $721.66 | $970.45 | $1,567.40 |