- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $966.38 / $3,839.00 / $8,247.00
| Facility | | $966.38 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $872.88 / $974.37 / $1,330.56
| Professional | | $872.88 | $974.37 | $1,330.56 |
- 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
- $1,074.53 / $1,115.08 / $1,115.08
| Professional | | $1,074.53 | $1,115.08 | $1,115.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,012.84 / $1,327.28 / $2,175.53
| Professional | | $1,012.84 | $1,327.28 | $2,175.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,265.02 / $1,676.40 / $1,682.17
| Professional | | $1,265.02 | $1,676.40 | $1,682.17 |
- 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
- $906.57 / $1,044.33 / $2,854.19
| Professional | | $906.57 | $1,044.33 | $2,854.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $1,139.70 / $2,760.60
| Professional | | $6.00 | $1,139.70 | $2,760.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,013.71 / $1,368.51 / $2,226.35
| Professional | | $1,013.71 | $1,368.51 | $2,226.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,006.07 / $1,060.96 / $1,060.96
| Facility | | $1,006.07 | $1,060.96 | $1,060.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,006.07 / $1,060.96 / $1,117.55
| Professional | | $1,006.07 | $1,060.96 | $1,117.55 |
- 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
- $958.06 / $1,335.64 / $2,231.23
| Professional | | $958.06 | $1,335.64 | $2,231.23 |