- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,749.00 / $5,040.00 / $10,637.11
| Facility | | $1,749.00 | $5,040.00 | $10,637.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $922.87 / $1,052.44 / $1,420.19
| Professional | | $922.87 | $1,052.44 | $1,420.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,524.00 / $22,312.00 / $37,718.00
| Facility | | $12,524.00 | $22,312.00 | $37,718.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $936.72 / $1,197.85 / $1,980.42
| Professional | | $936.72 | $1,197.85 | $1,980.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,095.48 / $1,139.43 / $15,406.00
| Professional | | $1,095.48 | $1,139.43 | $15,406.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $640.00 / $1,144.23
| Facility | | $640.00 | $640.00 | $1,144.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $989.66 / $1,291.00 / $2,209.50
| Professional | | $989.66 | $1,291.00 | $2,209.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $965.52 / $1,235.86 / $1,457.03
| Professional | | $965.52 | $1,235.86 | $1,457.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,049.18 / $1,332.21 / $1,990.68
| Facility | | $1,049.18 | $1,332.21 | $1,990.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,249.00 / $1,417.17 / $1,950.00
| Professional | | $1,249.00 | $1,417.17 | $1,950.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $958.64 / $1,285.11 / $4,391.63
| Facility | | $958.64 | $1,285.11 | $4,391.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $958.64 / $1,285.11 / $4,391.63
| Professional | | $958.64 | $1,285.11 | $4,391.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,621.00 / $20,974.00 / $40,876.00
| Facility | | $7,621.00 | $20,974.00 | $40,876.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $796.27 / $1,246.82 / $1,985.85
| Professional | | $796.27 | $1,246.82 | $1,985.85 |