- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.23 / $3,839.00 / $8,247.00
| Facility | | $773.23 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $637.41 / $711.28 / $891.36
| Professional | | $637.41 | $711.28 | $891.36 |
- 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
- $564.39 / $837.66 / $1,221.33
| Professional | | $564.39 | $837.66 | $1,221.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $635.54 / $818.47 / $1,297.61
| Professional | | $635.54 | $818.47 | $1,297.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $987.13 / $987.13 / $1,025.57
| Professional | | $987.13 | $987.13 | $1,025.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.23 / $4,761.00 / $8,247.00
| Facility | | $773.23 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $637.41 / $773.23 / $3,328.48
| Professional | | $637.41 | $773.23 | $3,328.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $642.10 / $732.50 / $1,606.70
| Professional | | $642.10 | $732.50 | $1,606.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $663.99 / $831.67 / $1,380.05
| Professional | | $663.99 | $831.67 | $1,380.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $573.36 / $626.59 / $626.59
| Facility | | $573.36 | $626.59 | $626.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $573.36 / $626.59 / $658.34
| Professional | | $573.36 | $626.59 | $658.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.00 / $2,391.00 / $6,322.00
| Facility | | $656.00 | $2,391.00 | $6,322.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $623.39 / $875.26 / $1,325.23
| Professional | | $623.39 | $875.26 | $1,325.23 |