- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.00 / $2,747.00 / $8,017.00
| Facility | | $832.00 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $594.64 / $665.95 / $1,753.71
| Professional | | $594.64 | $665.95 | $1,753.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.35 / $6,182.00 / $17,094.48
| Facility | | $5,058.35 | $6,182.00 | $17,094.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $680.58 / $1,079.08 / $1,274.98
| Professional | | $680.58 | $1,079.08 | $1,274.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $656.11 / $907.53 / $1,411.04
| Professional | | $656.11 | $907.53 | $1,411.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $795.92 / $1,053.22 / $1,060.05
| Professional | | $795.92 | $1,053.22 | $1,060.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,932.26 / $6,932.26 / $6,932.26
| Facility | | $6,932.26 | $6,932.26 | $6,932.26 |
- 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
- $620.21 / $779.33 / $2,467.00
| Professional | | $620.21 | $779.33 | $2,467.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $3.00 / $1,693.30
| Professional | | $3.00 | $3.00 | $1,693.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $706.27 / $918.61 / $1,574.67
| Professional | | $706.27 | $918.61 | $1,574.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $658.78 / $658.78 / $752.73
| Facility | | $658.78 | $658.78 | $752.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $639.86 / $660.90 / $752.73
| Professional | | $639.86 | $660.90 | $752.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,747.00 / $2,824.00 / $5,678.00
| Facility | | $1,747.00 | $2,824.00 | $5,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $685.63 / $832.36 / $1,372.29
| Professional | | $685.63 | $832.36 | $1,372.29 |