- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $976.00 / $3,830.00 / $8,240.00
| Facility | | $976.00 | $3,830.00 | $8,240.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $664.12 / $735.01 / $1,272.11
| Professional | | $664.12 | $735.01 | $1,272.11 |
- 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
- $745.74 / $773.88 / $773.88
| Professional | | $745.74 | $773.88 | $773.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $857.48 / $857.48 / $857.48
| Facility | | $857.48 | $857.48 | $857.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.65 / $889.22 / $1,532.30
| Professional | | $691.65 | $889.22 | $1,532.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $893.88 / $1,206.51 / $1,543.98
| Professional | | $893.88 | $1,206.51 | $1,543.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $4,597.00 / $8,404.00
| Facility | | $1,020.00 | $4,597.00 | $8,404.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $664.12 / $808.19 / $2,337.00
| Professional | | $664.12 | $808.19 | $2,337.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $904.50 / $904.50 / $1,610.30
| Professional | | $904.50 | $904.50 | $1,610.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $857.48 / $857.48 / $857.48
| Facility | | $857.48 | $857.48 | $857.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.61 / $906.61 / $1,557.55
| Professional | | $692.61 | $906.61 | $1,557.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $742.74 / $742.74 / $812.81
| Facility | | $742.74 | $742.74 | $812.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $725.85 / $742.74 / $812.81
| Professional | | $725.85 | $742.74 | $812.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $3,475.00 / $6,368.00
| Facility | | $2,155.00 | $3,475.00 | $6,368.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $671.86 / $887.00 / $1,427.90
| Professional | | $671.86 | $887.00 | $1,427.90 |