- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $846.67 / $2,747.00 / $8,017.00
| Facility | | $846.67 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $703.08 / $800.32 / $1,006.48
| Professional | | $703.08 | $800.32 | $1,006.48 |
- 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
- $793.77 / $823.72 / $1,469.47
| Professional | | $793.77 | $823.72 | $1,469.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $765.38 / $1,024.20 / $1,607.34
| Professional | | $765.38 | $1,024.20 | $1,607.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.85 / $1,223.66 / $1,228.40
| Professional | | $924.85 | $1,223.66 | $1,228.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $934.00 / $3,120.00 / $8,017.00
| Facility | | $934.00 | $3,120.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $703.08 / $851.28 / $2,605.00
| Professional | | $703.08 | $851.28 | $2,605.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $908.00 / $1,969.70
| Professional | | $3.00 | $908.00 | $1,969.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $774.73 / $1,034.41 / $1,677.38
| Professional | | $774.73 | $1,034.41 | $1,677.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $770.21 / $770.21 / $846.63
| Facility | | $770.21 | $770.21 | $846.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $747.10 / $773.73 / $846.63
| Professional | | $747.10 | $773.73 | $846.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $7,000.00 / $11,238.00
| Facility | | $3,340.00 | $7,000.00 | $11,238.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $787.61 / $998.70 / $1,677.79
| Professional | | $787.61 | $998.70 | $1,677.79 |