- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $905.44 / $3,745.00 / $8,017.00
| Facility | | $905.44 | $3,745.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $748.82 / $807.64 / $1,060.50
| Professional | | $748.82 | $807.64 | $1,060.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.91 / $11,851.00 / $28,970.26
| Facility | | $8,639.91 | $11,851.00 | $28,970.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $721.09 / $1,143.05 / $1,541.13
| Professional | | $721.09 | $1,143.05 | $1,541.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $772.03 / $1,041.15 / $1,705.56
| Professional | | $772.03 | $1,041.15 | $1,705.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $978.36 / $1,297.81 / $1,313.83
| Professional | | $978.36 | $1,297.81 | $1,313.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.00 / $3,839.00 / $8,017.00
| Facility | | $954.00 | $3,839.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $748.82 / $869.40 / $3,748.00
| Professional | | $748.82 | $869.40 | $3,748.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $888.90 / $2,199.69
| Professional | | $5.00 | $888.90 | $2,199.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $801.06 / $1,075.10 / $1,729.66
| Professional | | $801.06 | $1,075.10 | $1,729.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $785.76 / $818.44 / $818.44
| Facility | | $785.76 | $818.44 | $818.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $785.76 / $818.44 / $872.57
| Professional | | $785.76 | $818.44 | $872.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,334.00 / $2,824.00 / $5,678.00
| Facility | | $1,334.00 | $2,824.00 | $5,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $708.84 / $972.15 / $1,599.94
| Professional | | $708.84 | $972.15 | $1,599.94 |