- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $911.38 / $5,079.00 / $9,534.00
| Facility | | $911.38 | $5,079.00 | $9,534.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $666.74 / $817.03 / $1,124.71
| Professional | | $666.74 | $817.03 | $1,124.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,522.54 / $11,730.00 / $17,952.00
| Facility | | $9,522.54 | $11,730.00 | $17,952.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $678.00 / $678.00 / $678.00
| Facility | | $678.00 | $678.00 | $678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $627.55 / $878.88 / $1,412.47
| Professional | | $627.55 | $878.88 | $1,412.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,084.56 / $1,084.56 / $1,398.56
| Professional | | $1,084.56 | $1,084.56 | $1,398.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,298.00 / $5,403.00 / $9,830.00
| Facility | | $1,298.00 | $5,403.00 | $9,830.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $666.74 / $875.93 / $3,104.00
| Professional | | $666.74 | $875.93 | $3,104.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $1,542.43 / $2,038.02
| Professional | | $4.00 | $1,542.43 | $2,038.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $678.00 / $678.00 / $678.00
| Facility | | $678.00 | $678.00 | $678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.88 / $878.88 / $1,388.29
| Professional | | $655.88 | $878.88 | $1,388.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.59 / $832.59 / $883.63
| Facility | | $832.59 | $832.59 | $883.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $832.59 / $848.62 / $883.63
| Professional | | $832.59 | $848.62 | $883.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,228.00 / $3,879.00 / $7,508.00
| Facility | | $2,228.00 | $3,879.00 | $7,508.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $742.44 / $923.80 / $1,504.33
| Professional | | $742.44 | $923.80 | $1,504.33 |