- 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
- $893.32 / $1,112.56 / $1,406.45
| Professional | | $893.32 | $1,112.56 | $1,406.45 |
- 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
- $1,008.37 / $1,046.42 / $1,543.81
| Professional | | $1,008.37 | $1,046.42 | $1,543.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $995.88 / $1,302.82 / $2,037.82
| Professional | | $995.88 | $1,302.82 | $2,037.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,549.57 / $1,549.57 / $1,625.00
| Professional | | $1,549.57 | $1,549.57 | $1,625.00 |
- 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
- $888.65 / $1,132.66 / $2,843.00
| Professional | | $888.65 | $1,132.66 | $2,843.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $1,895.60 / $2,515.10
| Professional | | $15.00 | $1,895.60 | $2,515.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,021.90 / $1,307.05 / $2,037.82
| Professional | | $1,021.90 | $1,307.05 | $2,037.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $986.08 / $986.08 / $1,748.18
| Facility | | $986.08 | $986.08 | $1,748.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $944.00 / $1,003.00 / $1,748.18
| Professional | | $944.00 | $1,003.00 | $1,748.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $7,000.00 / $12,076.00
| Facility | | $3,340.00 | $7,000.00 | $12,076.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $944.32 / $1,286.70 / $2,014.88
| Professional | | $944.32 | $1,286.70 | $2,014.88 |