- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $910.40 / $4,122.00 / $8,404.00
| Facility | | $910.40 | $4,122.00 | $8,404.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.21 / $680.82 / $828.69
| Professional | | $565.21 | $680.82 | $828.69 |
- 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
- $639.10 / $663.21 / $663.21
| Professional | | $639.10 | $663.21 | $663.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $615.83 / $829.36 / $1,290.45
| Professional | | $615.83 | $829.36 | $1,290.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $746.50 / $987.89 / $992.77
| Professional | | $746.50 | $987.89 | $992.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,340.75 / $6,772.87 / $18,718.25
| Facility | | $4,340.75 | $6,772.87 | $18,718.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $935.52 / $4,597.00 / $8,404.00
| Facility | | $935.52 | $4,597.00 | $8,404.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.21 / $700.75 / $2,025.74
| Professional | | $565.21 | $700.75 | $2,025.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $798.70 / $1,590.20
| Professional | | $6.00 | $798.70 | $1,590.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $617.20 / $834.39 / $1,334.90
| Professional | | $617.20 | $834.39 | $1,334.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $619.54 / $619.54 / $707.10
| Facility | | $619.54 | $619.54 | $707.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $601.41 / $621.91 / $707.10
| Professional | | $601.41 | $621.91 | $707.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $3,475.00 / $6,000.00
| Facility | | $2,155.00 | $3,475.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.88 / $786.42 / $1,278.14
| Professional | | $593.88 | $786.42 | $1,278.14 |