- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $668.97 / $5,451.85 / $8,950.00
| Facility | | $668.97 | $5,451.85 | $8,950.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $699.77 / $4,024.39 / $7,181.88
| Professional | | $699.77 | $4,024.39 | $7,181.88 |
- 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
- $5,215.72 / $5,412.55 / $5,412.55
| Professional | | $5,215.72 | $5,412.55 | $5,412.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $810.57 / $1,783.02 / $10,497.25
| Professional | | $810.57 | $1,783.02 | $10,497.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,436.93 / $8,538.95 / $8,882.04
| Professional | | $6,436.93 | $8,538.95 | $8,882.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,524.91 / $24,748.55 / $26,970.99
| Facility | | $18,524.91 | $24,748.55 | $26,970.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $5,403.00 / $9,830.00
| Facility | | $1,020.00 | $5,403.00 | $9,830.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $699.77 / $4,024.39 / $8,886.51
| Professional | | $699.77 | $4,024.39 | $8,886.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $1,336.60 / $16,427.80
| Professional | | $5.00 | $1,336.60 | $16,427.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $828.46 / $1,793.82 / $10,501.27
| Professional | | $828.46 | $1,793.82 | $10,501.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $742.68 / $1,126.91 / $5,495.94
| Facility | | $742.68 | $1,126.91 | $5,495.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $742.68 / $4,590.72 / $6,009.65
| Professional | | $742.68 | $4,590.72 | $6,009.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,627.00 / $10,855.00 / $29,762.93
| Facility | | $3,627.00 | $10,855.00 | $29,762.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,232.67 / $6,741.09 / $11,782.84
| Professional | | $1,232.67 | $6,741.09 | $11,782.84 |