- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.86 / $2,747.00 / $8,017.00
| Facility | | $954.86 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $712.59 / $859.89 / $1,190.11
| Professional | | $712.59 | $859.89 | $1,190.11 |
- 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
- $831.67 / $863.05 / $1,366.62
| Professional | | $831.67 | $863.05 | $1,366.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.00 / $480.00 / $480.00
| Facility | | $480.00 | $480.00 | $480.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.12 / $823.82 / $1,349.90
| Professional | | $630.12 | $823.82 | $1,349.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,015.39 / $1,015.39 / $1,309.36
| Professional | | $1,015.39 | $1,015.39 | $1,309.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.00 / $3,120.00 / $8,017.00
| Facility | | $954.00 | $3,120.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $728.14 / $954.86 / $4,265.22
| Professional | | $728.14 | $954.86 | $4,265.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.20 / $724.20 / $724.20
| Professional | | $724.20 | $724.20 | $724.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.00 / $480.00 / $480.00
| Facility | | $480.00 | $480.00 | $480.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $643.83 / $863.05 / $1,349.90
| Professional | | $643.83 | $863.05 | $1,349.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.14 / $834.32 / $834.32
| Facility | | $707.14 | $834.32 | $834.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.14 / $834.32 / $892.77
| Professional | | $707.14 | $834.32 | $892.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $5,509.00 / $12,137.37
| Facility | | $2,332.00 | $5,509.00 | $12,137.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $665.54 / $864.97 / $1,532.75
| Professional | | $665.54 | $864.97 | $1,532.75 |