- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $752.25 / $3,839.00 / $8,247.00
| Facility | | $752.25 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $628.69 / $732.45 / $901.63
| Professional | | $628.69 | $732.45 | $901.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,431.95 / $7,827.00 / $19,139.18
| Facility | | $6,431.95 | $7,827.00 | $19,139.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $622.55 / $994.13 / $1,349.76
| Professional | | $622.55 | $994.13 | $1,349.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $680.89 / $930.45 / $1,453.69
| Professional | | $680.89 | $930.45 | $1,453.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.40 / $1,079.86 / $1,079.86
| Professional | | $816.40 | $1,079.86 | $1,079.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.00 / $4,761.00 / $8,247.00
| Facility | | $760.00 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $628.69 / $752.25 / $1,806.53
| Professional | | $628.69 | $752.25 | $1,806.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $962.10 / $1,736.60
| Professional | | $7.00 | $962.10 | $1,736.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $699.13 / $940.38 / $1,633.76
| Professional | | $699.13 | $940.38 | $1,633.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $687.80 / $687.80 / $993.91
| Facility | | $687.80 | $687.80 | $993.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $664.97 / $693.00 / $993.91
| Professional | | $664.97 | $693.00 | $993.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $3,914.00 / $7,000.00
| Facility | | $2,332.00 | $3,914.00 | $7,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $689.72 / $881.07 / $1,463.18
| Professional | | $689.72 | $881.07 | $1,463.18 |