- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $731.24 / $3,839.00 / $8,247.00
| Facility | | $731.24 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.77 / $749.55 / $1,014.16
| Professional | | $660.77 | $749.55 | $1,014.16 |
- 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
- $814.37 / $845.10 / $845.10
| Professional | | $814.37 | $845.10 | $845.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $768.27 / $1,038.47 / $1,646.18
| Professional | | $768.27 | $1,038.47 | $1,646.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $962.93 / $1,280.07 / $1,280.07
| Professional | | $962.93 | $1,280.07 | $1,280.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $731.24 / $4,761.00 / $8,247.00
| Facility | | $731.24 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $683.39 / $804.65 / $2,143.46
| Professional | | $683.39 | $804.65 | $2,143.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $923.20 / $2,068.19
| Professional | | $6.00 | $923.20 | $2,068.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.62 / $1,053.56 / $1,699.21
| Professional | | $776.62 | $1,053.56 | $1,699.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $737.80 / $804.49 / $804.49
| Facility | | $737.80 | $804.49 | $804.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.80 / $804.49 / $845.48
| Professional | | $737.80 | $804.49 | $845.48 |
- 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
- $765.89 / $1,044.41 / $1,597.77
| Professional | | $765.89 | $1,044.41 | $1,597.77 |