- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $926.00 / $4,264.00 / $8,240.00
| Facility | | $926.00 | $4,264.00 | $8,240.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $925.27 / $1,083.48 / $1,343.20
| Professional | | $925.27 | $1,083.48 | $1,343.20 |
- 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
- $931.90 / $1,484.99 / $2,079.98
| Professional | | $931.90 | $1,484.99 | $2,079.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,019.20 / $1,363.86 / $2,175.44
| Professional | | $1,019.20 | $1,363.86 | $2,175.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,229.89 / $1,627.14 / $1,632.82
| Professional | | $1,229.89 | $1,627.14 | $1,632.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,978.18 / $8,978.18 / $8,978.18
| Facility | | $8,978.18 | $8,978.18 | $8,978.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $4,761.00 / $8,247.00
| Facility | | $1,013.00 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $925.27 / $1,135.42 / $4,831.00
| Professional | | $925.27 | $1,135.42 | $4,831.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $1,397.50 / $2,623.00
| Professional | | $3.00 | $1,397.50 | $2,623.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,046.52 / $1,377.44 / $2,256.16
| Professional | | $1,046.52 | $1,377.44 | $2,256.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,027.41 / $1,027.41 / $1,238.16
| Facility | | $1,027.41 | $1,027.41 | $1,238.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $995.90 / $1,032.56 / $1,238.16
| Professional | | $995.90 | $1,032.56 | $1,238.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,334.00 / $2,824.00 / $5,678.00
| Facility | | $1,334.00 | $2,824.00 | $5,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $962.62 / $1,314.42 / $2,280.54
| Professional | | $962.62 | $1,314.42 | $2,280.54 |