- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $677.78 / $3,839.00 / $8,247.00
| Facility | | $677.78 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $615.99 / $709.07 / $938.99
| Professional | | $615.99 | $709.07 | $938.99 |
- 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
- $766.86 / $795.80 / $795.80
| Professional | | $766.86 | $795.80 | $795.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $731.25 / $976.66 / $1,525.82
| Professional | | $731.25 | $976.66 | $1,525.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $895.56 / $1,184.94 / $1,191.90
| Professional | | $895.56 | $1,184.94 | $1,191.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $677.78 / $4,761.00 / $8,247.00
| Facility | | $677.78 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $632.54 / $746.01 / $1,998.35
| Professional | | $632.54 | $746.01 | $1,998.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $898.10 / $1,071.09 / $1,929.10
| Professional | | $898.10 | $1,071.09 | $1,929.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $744.49 / $979.80 / $1,582.06
| Professional | | $744.49 | $979.80 | $1,582.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.16 / $748.16 / $832.56
| Facility | | $748.16 | $748.16 | $832.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $726.48 / $750.78 / $832.56
| Professional | | $726.48 | $750.78 | $832.56 |
- 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
- $722.02 / $939.09 / $1,521.90
| Professional | | $722.02 | $939.09 | $1,521.90 |