- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $747.51 / $3,839.00 / $8,247.00
| Facility | | $747.51 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.41 / $765.74 / $1,036.09
| Professional | | $675.41 | $765.74 | $1,036.09 |
- 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
- $832.28 / $863.69 / $863.69
| Professional | | $832.28 | $863.69 | $863.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $785.17 / $1,061.48 / $1,682.81
| Professional | | $785.17 | $1,061.48 | $1,682.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $984.12 / $1,308.23 / $1,308.23
| Professional | | $984.12 | $1,308.23 | $1,308.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $747.51 / $4,761.00 / $8,247.00
| Facility | | $747.51 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $698.16 / $822.37 / $2,190.94
| Professional | | $698.16 | $822.37 | $2,190.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $934.90 / $2,114.00
| Professional | | $6.00 | $934.90 | $2,114.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $793.66 / $1,075.92 / $1,748.05
| Professional | | $793.66 | $1,075.92 | $1,748.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.73 / $821.88 / $821.88
| Facility | | $758.73 | $821.88 | $821.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.73 / $821.88 / $863.75
| Professional | | $758.73 | $821.88 | $863.75 |
- 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
- $773.07 / $1,048.67 / $1,674.61
| Professional | | $773.07 | $1,048.67 | $1,674.61 |