- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $993.85 / $3,839.00 / $8,247.00
| Facility | | $993.85 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $825.71 / $988.74 / $1,212.68
| Professional | | $825.71 | $988.74 | $1,212.68 |
- 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
- $821.75 / $1,307.42 / $1,806.44
| Professional | | $821.75 | $1,307.42 | $1,806.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $890.99 / $1,201.48 / $1,889.63
| Professional | | $890.99 | $1,201.48 | $1,889.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,084.70 / $1,435.13 / $1,440.01
| Professional | | $1,084.70 | $1,435.13 | $1,440.01 |
- 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
- $825.71 / $993.85 / $2,396.67
| Professional | | $825.71 | $993.85 | $2,396.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $1,164.50 / $2,310.00
| Professional | | $7.00 | $1,164.50 | $2,310.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $898.27 / $1,214.01 / $1,933.31
| Professional | | $898.27 | $1,214.01 | $1,933.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $904.55 / $904.55 / $1,061.61
| Facility | | $904.55 | $904.55 | $1,061.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $877.01 / $909.10 / $1,061.61
| Professional | | $877.01 | $909.10 | $1,061.61 |
- 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
- $906.15 / $1,147.67 / $1,901.06
| Professional | | $906.15 | $1,147.67 | $1,901.06 |