- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $857.53 / $3,839.00 / $8,247.00
| Facility | | $857.53 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $806.27 / $857.53 / $976.92
| Professional | | $806.27 | $857.53 | $976.92 |
- 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
- $860.73 / $893.21 / $1,413.66
| Professional | | $860.73 | $893.21 | $1,413.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $850.64 / $1,134.77 / $1,863.19
| Professional | | $850.64 | $1,134.77 | $1,863.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,035.16 / $1,386.59 / $1,386.59
| Professional | | $1,035.16 | $1,386.59 | $1,386.59 |
- 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
- $784.29 / $871.64 / $2,843.00
| Professional | | $784.29 | $871.64 | $2,843.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.00 / $1,308.90 / $2,147.80
| Professional | | $12.00 | $1,308.90 | $2,147.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $861.08 / $1,137.13 / $1,894.19
| Professional | | $861.08 | $1,137.13 | $1,894.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.23 / $842.23 / $1,048.74
| Facility | | $842.23 | $842.23 | $1,048.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $806.36 / $856.60 / $1,048.74
| Professional | | $806.36 | $856.60 | $1,048.74 |
- 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
- $773.35 / $1,087.84 / $1,780.65
| Professional | | $773.35 | $1,087.84 | $1,780.65 |