- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $921.00 / $4,894.00 / $9,534.00
| Facility | | $921.00 | $4,894.00 | $9,534.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.91 / $748.87 / $987.18
| Professional | | $641.91 | $748.87 | $987.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.91 / $11,851.00 / $28,970.26
| Facility | | $8,639.91 | $11,851.00 | $28,970.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $698.96 / $1,108.34 / $1,473.44
| Professional | | $698.96 | $1,108.34 | $1,473.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $769.12 / $1,030.72 / $1,601.09
| Professional | | $769.12 | $1,030.72 | $1,601.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $934.49 / $1,242.28 / $1,242.28
| Professional | | $934.49 | $1,242.28 | $1,242.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80,737.25 / $80,737.25 / $80,737.25
| Facility | | $80,737.25 | $80,737.25 | $80,737.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $5,350.00 / $10,247.00
| Facility | | $1,020.00 | $5,350.00 | $10,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.75 / $827.59 / $4,174.72
| Professional | | $681.75 | $827.59 | $4,174.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $988.50 / $1,996.50
| Professional | | $6.00 | $988.50 | $1,996.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $769.75 / $1,033.39 / $1,811.60
| Professional | | $769.75 | $1,033.39 | $1,811.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $781.92 / $781.92 / $836.89
| Facility | | $781.92 | $781.92 | $836.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $754.93 / $788.97 / $836.89
| Professional | | $754.93 | $788.97 | $836.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,304.00 / $4,563.00 / $8,261.00
| Facility | | $2,304.00 | $4,563.00 | $8,261.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $751.92 / $1,001.64 / $1,612.24
| Professional | | $751.92 | $1,001.64 | $1,612.24 |