- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $801.60 / $3,839.00 / $8,427.00
| Facility | | $801.60 | $3,839.00 | $8,427.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $728.52 / $780.41 / $1,218.88
| Professional | | $728.52 | $780.41 | $1,218.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.35 / $6,182.00 / $17,094.48
| Facility | | $5,058.35 | $6,182.00 | $17,094.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $876.68 / $909.77 / $1,586.44
| Professional | | $876.68 | $909.77 | $1,586.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $715.82 / $950.10 / $1,657.64
| Professional | | $715.82 | $950.10 | $1,657.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,050.68 / $1,350.88 / $1,397.84
| Professional | | $1,050.68 | $1,350.88 | $1,397.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.00 / $4,068.00 / $8,017.00
| Facility | | $954.00 | $4,068.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.37 / $976.24 / $4,605.75
| Professional | | $759.37 | $976.24 | $4,605.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $840.00 / $840.00 / $880.70
| Professional | | $840.00 | $840.00 | $880.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $991.33 / $991.33 / $991.33
| Facility | | $991.33 | $991.33 | $991.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $764.35 / $953.26 / $1,761.61
| Professional | | $764.35 | $953.26 | $1,761.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $855.32 / $855.32 / $866.27
| Facility | | $855.32 | $855.32 | $866.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $855.32 / $858.01 / $907.09
| Professional | | $855.32 | $858.01 | $907.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.00 / $2,715.00 / $4,815.00
| Facility | | $1,122.00 | $2,715.00 | $4,815.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $749.67 / $926.06 / $1,618.18
| Professional | | $749.67 | $926.06 | $1,618.18 |