- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $6,025.60 / $9,549.93
| Facility | | $912.01 | $6,025.60 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $338.84 / $1,000.00
| Professional | | $281.84 | $338.84 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $7,585.78 / $57,543.99
| Facility | | $6,456.54 | $7,585.78 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $478.63
| Professional | | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $398.11 / $616.60
| Professional | | $302.00 | $398.11 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $407.38 / $446.68
| Professional | | $316.23 | $407.38 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $389.05 / $575.44
| Professional | | $288.40 | $389.05 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,897.79 / $9,549.93
| Facility | | $1,023.29 | $4,897.79 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $398.11 / $1,174.90
| Professional | | $295.12 | $398.11 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $616.60
| Facility | | $501.19 | $501.19 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $478.63 / $676.08
| Professional | | $389.05 | $478.63 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $436.52 / $691.83
| Facility | | $302.00 | $436.52 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $467.74 / $691.83
| Professional | | $295.12 | $467.74 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,981.07 / $21,877.62
| Facility | | $2,089.30 | $3,981.07 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $346.74 / $616.60
| Professional | | $263.03 | $346.74 | $616.60 |