- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $768.00 / $3,745.00 / $8,017.00
| Facility | | $768.00 | $3,745.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $699.81 / $807.47 / $1,014.06
| Professional | | $699.81 | $807.47 | $1,014.06 |
- 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
- $705.47 / $829.97 / $829.97
| Professional | | $705.47 | $829.97 | $829.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $771.22 / $1,040.66 / $1,620.41
| Professional | | $771.22 | $1,040.66 | $1,620.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $932.41 / $1,233.71 / $1,238.89
| Professional | | $932.41 | $1,233.71 | $1,238.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.00 / $3,839.00 / $8,017.00
| Facility | | $954.00 | $3,839.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $700.00 / $822.57 / $3,748.00
| Professional | | $700.00 | $822.57 | $3,748.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $1,097.20 / $1,986.70
| Professional | | $3.00 | $1,097.20 | $1,986.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $787.70 / $1,078.64 / $1,715.25
| Professional | | $787.70 | $1,078.64 | $1,715.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.19 / $776.19 / $916.07
| Facility | | $776.19 | $776.19 | $916.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $753.06 / $779.57 / $916.07
| Professional | | $753.06 | $779.57 | $916.07 |
- 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
- $794.09 / $994.30 / $1,669.55
| Professional | | $794.09 | $994.30 | $1,669.55 |