- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $907.87 / $3,839.00 / $8,247.00
| Facility | | $907.87 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $766.40 / $868.84 / $1,134.43
| Professional | | $766.40 | $868.84 | $1,134.43 |
- 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
- $947.74 / $983.50 / $983.50
| Professional | | $947.74 | $983.50 | $983.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $904.42 / $1,181.00 / $1,852.37
| Professional | | $904.42 | $1,181.00 | $1,852.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,158.35 / $1,558.06 / $1,558.06
| Professional | | $1,158.35 | $1,558.06 | $1,558.06 |
- 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
- $766.40 / $944.30 / $2,469.35
| Professional | | $766.40 | $944.30 | $2,469.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $1,069.09 / $2,378.69
| Professional | | $6.00 | $1,069.09 | $2,378.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $904.42 / $1,181.00 / $1,926.35
| Professional | | $904.42 | $1,181.00 | $1,926.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $845.67 / $934.03 / $934.03
| Facility | | $845.67 | $934.03 | $934.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $845.67 / $934.03 / $986.05
| Professional | | $845.67 | $934.03 | $986.05 |
- 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
- $858.27 / $1,108.16 / $1,902.53
| Professional | | $858.27 | $1,108.16 | $1,902.53 |