- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $930.82 / $2,747.00 / $8,017.00
| Facility | | $930.82 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $773.16 / $880.41 / $1,108.41
| Professional | | $773.16 | $880.41 | $1,108.41 |
- 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
- $872.77 / $905.71 / $905.71
| Professional | | $872.77 | $905.71 | $905.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $841.77 / $1,126.63 / $1,771.22
| Professional | | $841.77 | $1,126.63 | $1,771.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,016.65 / $1,345.13 / $1,350.05
| Professional | | $1,016.65 | $1,345.13 | $1,350.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $934.00 / $3,120.00 / $8,017.00
| Facility | | $934.00 | $3,120.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $773.16 / $930.82 / $2,843.00
| Professional | | $773.16 | $930.82 | $2,843.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $1,119.20 / $2,165.00
| Professional | | $3.00 | $1,119.20 | $2,165.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.54 / $1,137.65 / $1,815.25
| Professional | | $851.54 | $1,137.65 | $1,815.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $847.98 / $847.98 / $1,065.94
| Facility | | $847.98 | $847.98 | $1,065.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $822.32 / $852.08 / $1,065.94
| Professional | | $822.32 | $852.08 | $1,065.94 |
- 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
- $854.88 / $1,068.23 / $1,767.28
| Professional | | $854.88 | $1,068.23 | $1,767.28 |