- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $5,011.87 / $8,317.64
| Facility | | $1,000.00 | $5,011.87 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $912.01 / $1,778.28
| Professional | | $776.25 | $912.01 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,760.83 / $7,413.10
| Facility | | $5,888.44 | $6,760.83 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,230.27 / $1,698.24
| Professional | | $870.96 | $1,230.27 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $4,466.84 / $6,918.31
| Professional | | $954.99 | $4,466.84 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,584.89 / $1,862.09
| Facility | | $1,584.89 | $1,584.89 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,071.52 / $1,862.09
| Professional | | $812.83 | $1,071.52 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,000.00 / $1,174.90
| Professional | | $831.76 | $1,000.00 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,122.02 / $1,380.38
| Professional | | $1,122.02 | $1,122.02 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,047.13 / $1,621.81
| Facility | | $812.83 | $1,047.13 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $1,819.70 / $1,819.70
| Professional | | $1,819.70 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,202.26 / $10,000.00
| Facility | | $776.25 | $1,202.26 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,202.26 / $10,000.00
| Professional | | $776.25 | $1,202.26 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $9,549.93 / $19,054.61
| Facility | | $5,623.41 | $9,549.93 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $977.24 / $1,698.24
| Professional | | $660.69 | $977.24 | $1,698.24 |