- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $5,254.00 / $10,398.00
| Facility | | $1,013.00 | $5,254.00 | $10,398.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $717.69 / $801.17 / $1,022.17
| Professional | | $717.69 | $801.17 | $1,022.17 |
- 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
- $801.72 / $831.97 / $831.97
| Professional | | $801.72 | $831.97 | $831.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $763.19 / $1,022.44 / $1,602.82
| Professional | | $763.19 | $1,022.44 | $1,602.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $936.92 / $1,239.74 / $1,247.39
| Professional | | $936.92 | $1,239.74 | $1,247.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,301.00 / $5,526.00 / $11,083.00
| Facility | | $1,301.00 | $5,526.00 | $11,083.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $717.69 / $863.02 / $4,168.16
| Professional | | $717.69 | $863.02 | $4,168.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $1,067.80 / $2,026.10
| Professional | | $6.00 | $1,067.80 | $2,026.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.49 / $1,049.42 / $1,707.11
| Professional | | $776.49 | $1,049.42 | $1,707.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $783.32 / $783.32 / $980.45
| Facility | | $783.32 | $783.32 | $980.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $760.80 / $785.86 / $980.45
| Professional | | $760.80 | $785.86 | $980.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,747.00 / $2,824.00 / $5,678.00
| Facility | | $1,747.00 | $2,824.00 | $5,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $765.31 / $973.65 / $1,586.89
| Professional | | $765.31 | $973.65 | $1,586.89 |