- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $824.35 / $3,839.00 / $8,247.00
| Facility | | $824.35 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $729.69 / $794.59 / $959.18
| Professional | | $729.69 | $794.59 | $959.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.91 / $11,851.00 / $28,970.26
| Facility | | $8,639.91 | $11,851.00 | $28,970.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $603.50 / $951.92 / $1,377.32
| Professional | | $603.50 | $951.92 | $1,377.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $669.66 / $919.91 / $1,418.73
| Professional | | $669.66 | $919.91 | $1,418.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,036.45 / $1,036.45 / $1,099.76
| Professional | | $1,036.45 | $1,036.45 | $1,099.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $824.35 / $4,761.00 / $8,247.00
| Facility | | $824.35 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $700.00 / $824.35 / $3,791.52
| Professional | | $700.00 | $824.35 | $3,791.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $1,010.00 / $1,684.80
| Professional | | $5.00 | $1,010.00 | $1,684.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $729.56 / $947.71 / $1,464.88
| Professional | | $729.56 | $947.71 | $1,464.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $669.21 / $669.21 / $755.32
| Facility | | $669.21 | $669.21 | $755.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $637.64 / $682.59 / $755.32
| Professional | | $637.64 | $682.59 | $755.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,440.00 / $3,475.00 / $6,000.00
| Facility | | $1,440.00 | $3,475.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $690.16 / $922.43 / $1,444.45
| Professional | | $690.16 | $922.43 | $1,444.45 |