- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.12 / $3,839.00 / $8,247.00
| Facility | | $776.12 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $608.20 / $691.77 / $1,246.77
| Professional | | $608.20 | $691.77 | $1,246.77 |
- 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
- $499.42 / $825.23 / $1,155.52
| Professional | | $499.42 | $825.23 | $1,155.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.96 / $791.38 / $1,302.47
| Professional | | $588.96 | $791.38 | $1,302.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $859.49 / $859.49 / $910.00
| Professional | | $859.49 | $859.49 | $910.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,357.51 / $8,357.51 / $8,357.51
| Facility | | $8,357.51 | $8,357.51 | $8,357.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.12 / $4,761.00 / $8,247.00
| Facility | | $776.12 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $608.20 / $768.64 / $2,843.00
| Professional | | $608.20 | $768.64 | $2,843.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $862.40 / $1,609.80
| Professional | | $4.00 | $862.40 | $1,609.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.26 / $817.11 / $1,302.47
| Professional | | $614.26 | $817.11 | $1,302.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.60 / $626.52 / $626.52
| Facility | | $620.60 | $626.52 | $626.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $599.75 / $626.52 / $658.70
| Professional | | $599.75 | $626.52 | $658.70 |
- 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
- $577.55 / $773.53 / $1,268.98
| Professional | | $577.55 | $773.53 | $1,268.98 |