- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $981.91 / $5,526.00 / $13,947.00
| Facility | | $981.91 | $5,526.00 | $13,947.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $716.96 / $905.47 / $1,140.63
| Professional | | $716.96 | $905.47 | $1,140.63 |
- 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
- $713.81 / $1,088.53 / $1,571.17
| Professional | | $713.81 | $1,088.53 | $1,571.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $799.44 / $1,058.47 / $1,647.82
| Professional | | $799.44 | $1,058.47 | $1,647.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,224.50 / $1,224.50 / $1,291.22
| Professional | | $1,224.50 | $1,224.50 | $1,291.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $981.91 / $5,526.00 / $13,969.00
| Facility | | $981.91 | $5,526.00 | $13,969.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $716.96 / $981.91 / $4,221.79
| Professional | | $716.96 | $981.91 | $4,221.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.00 / $1,472.90 / $2,011.70
| Professional | | $20.00 | $1,472.90 | $2,011.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $839.79 / $1,099.15 / $1,647.82
| Professional | | $839.79 | $1,099.15 | $1,647.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $797.12 / $797.12 / $804.89
| Facility | | $797.12 | $797.12 | $804.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $760.77 / $804.89 / $831.47
| Professional | | $760.77 | $804.89 | $831.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.00 / $2,391.00 / $6,228.00
| Facility | | $656.00 | $2,391.00 | $6,228.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $840.96 / $1,206.90 / $1,840.77
| Professional | | $840.96 | $1,206.90 | $1,840.77 |