- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $824.86 / $4,680.00 / $9,534.00
| Facility | | $824.86 | $4,680.00 | $9,534.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.97 / $756.06 / $1,104.56
| Professional | | $273.97 | $756.06 | $1,104.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,850.00 / $16,455.00 / $36,032.05
| Facility | | $8,850.00 | $16,455.00 | $36,032.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $733.20 / $1,210.83 / $1,885.65
| Professional | | $733.20 | $1,210.83 | $1,885.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.19 / $733.31 / $1,948.08
| Professional | | $333.19 | $733.31 | $1,948.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,006.03 / $1,331.66 / $1,380.44
| Professional | | $1,006.03 | $1,331.66 | $1,380.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.00 / $5,342.00 / $9,830.00
| Facility | | $1,071.00 | $5,342.00 | $9,830.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.89 / $767.25 / $1,734.21
| Professional | | $274.89 | $767.25 | $1,734.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $2,166.80 / $2,627.20
| Professional | | $3.00 | $2,166.80 | $2,627.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.08 / $817.78 / $2,009.08
| Professional | | $347.08 | $817.78 | $2,009.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.48 / $846.70 / $1,719.96
| Facility | | $310.48 | $846.70 | $1,719.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.48 / $834.68 / $1,111.77
| Professional | | $310.48 | $834.68 | $1,111.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,304.00 / $4,563.00 / $8,261.00
| Facility | | $2,304.00 | $4,563.00 | $8,261.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $830.00 / $1,364.71 / $2,162.59
| Professional | | $830.00 | $1,364.71 | $2,162.59 |