- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $986.20 / $3,745.00 / $8,017.00
| Facility | | $986.20 | $3,745.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $819.33 / $921.15 / $1,173.88
| Professional | | $819.33 | $921.15 | $1,173.88 |
- 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
- $815.54 / $1,297.83 / $1,738.00
| Professional | | $815.54 | $1,297.83 | $1,738.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.34 / $1,188.57 / $1,881.76
| Professional | | $891.34 | $1,188.57 | $1,881.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,076.53 / $1,424.30 / $1,429.29
| Professional | | $1,076.53 | $1,424.30 | $1,429.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $986.20 / $3,964.00 / $8,017.00
| Facility | | $986.20 | $3,964.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $819.33 / $986.20 / $3,748.00
| Professional | | $819.33 | $986.20 | $3,748.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $1,208.30 / $2,292.40
| Professional | | $7.00 | $1,208.30 | $2,292.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.76 / $1,205.21 / $1,891.98
| Professional | | $891.76 | $1,205.21 | $1,891.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $897.92 / $897.92 / $974.99
| Facility | | $897.92 | $897.92 | $974.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.38 / $902.40 / $974.99
| Professional | | $870.38 | $902.40 | $974.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,334.00 / $2,824.00 / $5,678.00
| Facility | | $1,334.00 | $2,824.00 | $5,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $913.92 / $1,135.82 / $1,855.98
| Professional | | $913.92 | $1,135.82 | $1,855.98 |