- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $888.26 / $3,839.00 / $8,247.00
| Facility | | $888.26 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.01 / $820.43 / $1,020.81
| Professional | | $555.01 | $820.43 | $1,020.81 |
- 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
- $737.90 / $846.48 / $995.86
| Professional | | $737.90 | $846.48 | $995.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.70 / $841.38 / $1,389.30
| Professional | | $590.70 | $841.38 | $1,389.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,170.01 / $1,170.01 / $1,245.04
| Professional | | $1,170.01 | $1,170.01 | $1,245.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.00 / $4,761.00 / $8,247.00
| Facility | | $832.00 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $619.01 / $860.55 / $3,647.50
| Professional | | $619.01 | $860.55 | $3,647.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $727.80 / $1,858.00
| Professional | | $10.00 | $727.80 | $1,858.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.67 / $850.00 / $1,347.82
| Professional | | $596.67 | $850.00 | $1,347.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $474.66 / $715.77 / $715.77
| Facility | | $474.66 | $715.77 | $715.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.66 / $715.77 / $764.09
| Professional | | $474.66 | $715.77 | $764.09 |
- 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
- $566.45 / $831.14 / $1,353.45
| Professional | | $566.45 | $831.14 | $1,353.45 |