- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $596.63 / $2,747.00 / $8,017.00
| Facility | | $596.63 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.32 / $519.37 / $706.55
| Professional | | $391.32 | $519.37 | $706.55 |
- 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
- $522.73 / $542.45 / $946.21
| Professional | | $522.73 | $542.45 | $946.21 |
- 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
- $344.14 / $495.98 / $791.54
| Professional | | $344.14 | $495.98 | $791.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $639.69 / $639.69 / $824.90
| Professional | | $639.69 | $639.69 | $824.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $918.00 / $3,120.00 / $8,017.00
| Facility | | $918.00 | $3,120.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.28 / $530.46 / $2,523.66
| Professional | | $395.28 | $530.46 | $2,523.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.20 / $467.20 / $467.20
| Professional | | $467.20 | $467.20 | $467.20 |
- 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
- $358.68 / $505.33 / $776.62
| Professional | | $358.68 | $505.33 | $776.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $355.69 / $392.67 / $521.66
| Facility | | $355.69 | $392.67 | $521.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.00 / $416.84 / $558.84
| Professional | | $385.00 | $416.84 | $558.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,440.00 / $3,475.00 / $6,368.00
| Facility | | $1,440.00 | $3,475.00 | $6,368.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.50 / $603.58 / $949.61
| Professional | | $427.50 | $603.58 | $949.61 |