- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $743.59 / $5,868.00 / $11,043.00
| Facility | | $743.59 | $5,868.00 | $11,043.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.10 / $2,673.21 / $7,728.78
| Professional | | $477.10 | $2,673.21 | $7,728.78 |
- 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
- $4,274.04 / $8,623.24 / $11,811.19
| Professional | | $4,274.04 | $8,623.24 | $11,811.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.76 / $1,161.03 / $10,053.58
| Professional | | $537.76 | $1,161.03 | $10,053.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,954.26 / $7,954.26 / $8,272.41
| Professional | | $7,954.26 | $7,954.26 | $8,272.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $886.50 / $5,958.00 / $11,182.00
| Facility | | $886.50 | $5,958.00 | $11,182.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.10 / $2,673.21 / $9,177.02
| Professional | | $477.10 | $2,673.21 | $9,177.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.09 / $1,008.18 / $9,235.93
| Professional | | $504.09 | $1,008.18 | $9,235.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.71 / $1,161.03 / $9,939.96
| Professional | | $554.71 | $1,161.03 | $9,939.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $492.45 / $564.08 / $7,079.03
| Facility | | $492.45 | $564.08 | $7,079.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.45 / $564.08 / $5,686.34
| Professional | | $492.45 | $564.08 | $5,686.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,742.00 / $8,870.00 / $20,021.00
| Facility | | $3,742.00 | $8,870.00 | $20,021.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,125.73 / $7,709.80 / $12,452.05
| Professional | | $6,125.73 | $7,709.80 | $12,452.05 |