- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $790.31 / $3,839.00 / $8,247.00
| Facility | | $790.31 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $643.77 / $745.38 / $977.26
| Professional | | $643.77 | $745.38 | $977.26 |
- 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
- $701.03 / $727.49 / $1,292.83
| Professional | | $701.03 | $727.49 | $1,292.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.27 / $920.12 / $1,458.92
| Professional | | $676.27 | $920.12 | $1,458.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $818.29 / $1,082.70 / $1,088.52
| Professional | | $818.29 | $1,082.70 | $1,088.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $790.31 / $4,761.00 / $8,247.00
| Facility | | $790.31 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $650.52 / $750.97 / $1,899.91
| Professional | | $650.52 | $750.97 | $1,899.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $963.10 / $1,833.40
| Professional | | $6.00 | $963.10 | $1,833.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $680.54 / $949.11 / $1,538.42
| Professional | | $680.54 | $949.11 | $1,538.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $679.85 / $679.85 / $831.72
| Facility | | $679.85 | $679.85 | $831.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $659.82 / $682.55 / $831.72
| Professional | | $659.82 | $682.55 | $831.72 |
- 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
- $697.65 / $913.35 / $1,477.97
| Professional | | $697.65 | $913.35 | $1,477.97 |