- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.00 / $4,534.00 / $8,404.00
| Facility | | $882.00 | $4,534.00 | $8,404.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.44 / $560.34 / $653.60
| Professional | | $496.44 | $560.34 | $653.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,431.95 / $7,827.00 / $19,139.18
| Facility | | $6,431.95 | $7,827.00 | $19,139.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.31 / $787.96 / $787.96
| Professional | | $759.31 | $787.96 | $787.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.79 / $741.11 / $1,162.75
| Professional | | $535.79 | $741.11 | $1,162.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,171.98 / $1,612.57 / $1,612.57
| Professional | | $1,171.98 | $1,612.57 | $1,612.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,474.29 / $9,366.93 / $10,409.77
| Facility | | $5,474.29 | $9,366.93 | $10,409.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $976.00 / $4,761.00 / $8,404.00
| Facility | | $976.00 | $4,761.00 | $8,404.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $498.83 / $600.00 / $1,544.00
| Professional | | $498.83 | $600.00 | $1,544.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $1,007.10 / $1,246.59
| Professional | | $3.00 | $1,007.10 | $1,246.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $557.65 / $743.46 / $1,249.09
| Professional | | $557.65 | $743.46 | $1,249.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $742.45 / $742.45 / $1,046.35
| Facility | | $742.45 | $742.45 | $1,046.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $742.45 / $759.19 / $1,046.35
| Professional | | $742.45 | $759.19 | $1,046.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $3,475.00 / $6,000.00
| Facility | | $2,155.00 | $3,475.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.54 / $1,017.16 / $1,414.29
| Professional | | $645.54 | $1,017.16 | $1,414.29 |