- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.00 / $5,079.00 / $9,534.00
| Facility | | $882.00 | $5,079.00 | $9,534.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $574.41 / $637.41 / $1,011.76
| Professional | | $574.41 | $637.41 | $1,011.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.91 / $11,851.00 / $28,970.26
| Facility | | $8,639.91 | $11,851.00 | $28,970.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $578.89 / $920.37 / $1,388.93
| Professional | | $578.89 | $920.37 | $1,388.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $633.14 / $868.96 / $1,398.49
| Professional | | $633.14 | $868.96 | $1,398.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $764.84 / $1,011.98 / $1,015.96
| Professional | | $764.84 | $1,011.98 | $1,015.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,845.34 / $15,845.34 / $15,845.34
| Facility | | $15,845.34 | $15,845.34 | $15,845.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,298.00 / $5,350.00 / $9,830.00
| Facility | | $1,298.00 | $5,350.00 | $9,830.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.91 / $724.93 / $3,104.00
| Professional | | $600.91 | $724.93 | $3,104.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $862.60 / $1,629.70
| Professional | | $6.00 | $862.60 | $1,629.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $633.40 / $895.51 / $1,519.54
| Professional | | $633.40 | $895.51 | $1,519.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $636.77 / $636.77 / $677.96
| Facility | | $636.77 | $636.77 | $677.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $617.69 / $639.66 / $677.96
| Professional | | $617.69 | $639.66 | $677.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $7,000.00 / $18,778.52
| Facility | | $3,028.00 | $7,000.00 | $18,778.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $644.63 / $773.56 / $1,319.21
| Professional | | $644.63 | $773.56 | $1,319.21 |