- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $3,839.00 / $8,247.00
| Facility | | $1,020.00 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $880.37 / $1,054.69 / $1,333.70
| Professional | | $880.37 | $1,054.69 | $1,333.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,531.00 / $27,840.00 / $46,480.74
| Facility | | $13,531.00 | $27,840.00 | $46,480.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $956.57 / $992.66 / $1,464.29
| Professional | | $956.57 | $992.66 | $1,464.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $944.19 / $1,249.68 / $1,931.25
| Professional | | $944.19 | $1,249.68 | $1,931.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,471.17 / $1,471.17 / $1,541.79
| Professional | | $1,471.17 | $1,471.17 | $1,541.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.00 / $4,761.00 / $8,247.00
| Facility | | $832.00 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $880.37 / $1,066.23 / $2,301.60
| Professional | | $880.37 | $1,066.23 | $2,301.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $1,732.50 / $2,385.19
| Professional | | $15.00 | $1,732.50 | $2,385.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $980.45 / $1,271.70 / $1,931.25
| Professional | | $980.45 | $1,271.70 | $1,931.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $935.29 / $935.29 / $1,716.47
| Facility | | $935.29 | $935.29 | $1,716.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $895.58 / $951.14 / $1,716.47
| Professional | | $895.58 | $951.14 | $1,716.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,742.00 / $6,911.00 / $13,797.00
| Facility | | $3,742.00 | $6,911.00 | $13,797.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $899.33 / $1,208.09 / $1,911.83
| Professional | | $899.33 | $1,208.09 | $1,911.83 |