- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $997.90 / $2,747.00 / $8,017.00
| Facility | | $997.90 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $829.66 / $942.55 / $1,188.14
| Professional | | $829.66 | $942.55 | $1,188.14 |
- 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
- $934.45 / $969.72 / $969.72
| Professional | | $934.45 | $969.72 | $969.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $901.65 / $1,206.55 / $1,899.59
| Professional | | $901.65 | $1,206.55 | $1,899.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,087.11 / $1,438.27 / $1,442.39
| Professional | | $1,087.11 | $1,438.27 | $1,442.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.00 / $3,120.00 / $8,017.00
| Facility | | $954.00 | $3,120.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $829.66 / $997.90 / $2,963.76
| Professional | | $829.66 | $997.90 | $2,963.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $1,198.09 / $2,317.90
| Professional | | $3.00 | $1,198.09 | $2,317.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $916.33 / $1,218.58 / $1,991.83
| Professional | | $916.33 | $1,218.58 | $1,991.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $908.57 / $908.57 / $1,068.57
| Facility | | $908.57 | $908.57 | $1,068.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $880.73 / $913.35 / $1,068.57
| Professional | | $880.73 | $913.35 | $1,068.57 |
- 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
- $899.12 / $1,147.93 / $1,899.14
| Professional | | $899.12 | $1,147.93 | $1,899.14 |