- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.00 / $3,838.00 / $8,450.50
| Facility | | $657.00 | $3,838.00 | $8,450.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $670.76 / $1,853.85 / $9,018.29
| Professional | | $670.76 | $1,853.85 | $9,018.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,531.00 / $27,840.00 / $57,255.43
| Facility | | $13,531.00 | $27,840.00 | $57,255.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,224.53 / $10,202.82 / $12,272.46
| Professional | | $5,224.53 | $10,202.82 | $12,272.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $731.35 / $1,460.14 / $10,887.34
| Professional | | $731.35 | $1,460.14 | $10,887.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,701.64 / $9,701.64 / $10,104.92
| Professional | | $9,701.64 | $9,701.64 | $10,104.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,254.47 / $30,596.59 / $50,831.99
| Facility | | $5,254.47 | $30,596.59 | $50,831.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $768.00 / $4,102.00 / $8,450.50
| Facility | | $768.00 | $4,102.00 | $8,450.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $698.73 / $1,853.85 / $11,084.30
| Professional | | $698.73 | $1,853.85 | $11,084.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $891.00 / $19,010.09
| Professional | | $6.00 | $891.00 | $19,010.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $734.66 / $1,499.64 / $10,847.94
| Professional | | $734.66 | $1,499.64 | $10,847.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $639.15 / $782.08 / $7,041.74
| Facility | | $639.15 | $782.08 | $7,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $639.15 / $782.08 / $6,926.98
| Professional | | $639.15 | $782.08 | $6,926.98 |
- 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
- $6,496.19 / $8,302.54 / $13,653.29
| Professional | | $6,496.19 | $8,302.54 | $13,653.29 |