- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.73 / $3,839.00 / $8,247.00
| Facility | | $709.73 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $659.22 / $751.87 / $1,076.51
| Professional | | $659.22 | $751.87 | $1,076.51 |
- 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
- $790.53 / $820.36 / $820.36
| Professional | | $790.53 | $820.36 | $820.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.78 / $1,007.50 / $1,597.76
| Professional | | $745.78 | $1,007.50 | $1,597.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $935.40 / $1,243.58 / $1,243.58
| Professional | | $935.40 | $1,243.58 | $1,243.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.73 / $4,761.00 / $8,247.00
| Facility | | $709.73 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $663.43 / $806.37 / $2,081.12
| Professional | | $663.43 | $806.37 | $2,081.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $869.00 / $1,034.40 / $2,008.40
| Professional | | $869.00 | $1,034.40 | $2,008.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $753.34 / $1,021.18 / $1,641.71
| Professional | | $753.34 | $1,021.18 | $1,641.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $765.78 / $780.33 / $780.33
| Facility | | $765.78 | $780.33 | $780.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $754.65 / $780.33 / $820.37
| Professional | | $754.65 | $780.33 | $820.37 |
- 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
- $722.19 / $992.29 / $1,674.90
| Professional | | $722.19 | $992.29 | $1,674.90 |