- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.60 / $3,745.00 / $8,017.00
| Facility | | $860.60 | $3,745.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.78 / $809.02 / $1,052.35
| Professional | | $673.78 | $809.02 | $1,052.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,800.00 / $7,463.00 / $11,048.00
| Facility | | $2,800.00 | $7,463.00 | $11,048.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $693.46 / $719.63 / $719.63
| Professional | | $693.46 | $719.63 | $719.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $680.34 / $958.79 / $1,612.43
| Professional | | $680.34 | $958.79 | $1,612.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $832.18 / $1,104.08 / $1,119.23
| Professional | | $832.18 | $1,104.08 | $1,119.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,815.27 / $3,815.27 / $3,815.27
| Facility | | $3,815.27 | $3,815.27 | $3,815.27 |
- 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
- $691.35 / $824.88 / $3,494.00
| Professional | | $691.35 | $824.88 | $3,494.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $842.80 / $2,083.69
| Professional | | $5.00 | $842.80 | $2,083.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $706.29 / $959.33 / $1,621.10
| Professional | | $706.29 | $959.33 | $1,621.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.33 / $781.00 / $781.00
| Facility | | $776.33 | $781.00 | $781.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $762.41 / $781.00 / $830.68
| Professional | | $762.41 | $781.00 | $830.68 |
- 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
- $654.21 / $924.79 / $1,542.48
| Professional | | $654.21 | $924.79 | $1,542.48 |