- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $774.98 / $3,839.00 / $8,247.00
| Facility | | $774.98 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $644.66 / $723.84 / $1,016.92
| Professional | | $644.66 | $723.84 | $1,016.92 |
- 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
- $760.52 / $789.22 / $789.22
| Professional | | $760.52 | $789.22 | $789.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $733.71 / $968.58 / $1,586.36
| Professional | | $733.71 | $968.58 | $1,586.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $950.78 / $1,284.50 / $1,284.50
| Professional | | $950.78 | $1,284.50 | $1,284.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $774.98 / $4,761.00 / $8,247.00
| Facility | | $774.98 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $647.79 / $774.98 / $3,775.79
| Professional | | $647.79 | $774.98 | $3,775.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.00 / $751.60 / $1,908.30
| Professional | | $9.00 | $751.60 | $1,908.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $733.71 / $964.03 / $1,593.35
| Professional | | $733.71 | $964.03 | $1,593.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.49 / $737.84 / $737.84
| Facility | | $657.49 | $737.84 | $737.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $657.49 / $737.84 / $786.23
| Professional | | $657.49 | $737.84 | $786.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.00 / $2,391.00 / $6,228.00
| Facility | | $656.00 | $2,391.00 | $6,228.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $739.92 / $970.70 / $1,489.75
| Professional | | $739.92 | $970.70 | $1,489.75 |