- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $651.30 / $3,839.00 / $8,247.00
| Facility | | $651.30 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $651.30 / $738.46 / $944.77
| Professional | | $651.30 | $738.46 | $944.77 |
- 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
- $656.75 / $1,045.20 / $1,394.09
| Professional | | $656.75 | $1,045.20 | $1,394.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $714.45 / $961.26 / $1,508.86
| Professional | | $714.45 | $961.26 | $1,508.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $867.90 / $1,148.27 / $1,153.52
| Professional | | $867.90 | $1,148.27 | $1,153.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,977.06 / $10,977.06 / $10,977.06
| Facility | | $10,977.06 | $10,977.06 | $10,977.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.00 / $4,761.00 / $8,247.00
| Facility | | $832.00 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.25 / $752.93 / $3,111.00
| Professional | | $681.25 | $752.93 | $3,111.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $949.50 / $1,849.40
| Professional | | $6.00 | $949.50 | $1,849.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $718.83 / $971.50 / $1,546.80
| Professional | | $718.83 | $971.50 | $1,546.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $723.14 / $723.14 / $840.70
| Facility | | $723.14 | $723.14 | $840.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $701.58 / $726.30 / $840.70
| Professional | | $701.58 | $726.30 | $840.70 |
- 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
- $698.01 / $914.99 / $1,496.45
| Professional | | $698.01 | $914.99 | $1,496.45 |