- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.00 / $5,254.00 / $10,398.00
| Facility | | $1,100.00 | $5,254.00 | $10,398.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $914.48 / $994.41 / $1,301.24
| Professional | | $914.48 | $994.41 | $1,301.24 |
- 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
- $885.24 / $1,444.96 / $1,947.59
| Professional | | $885.24 | $1,444.96 | $1,947.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $969.14 / $1,312.93 / $2,072.04
| Professional | | $969.14 | $1,312.93 | $2,072.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,194.96 / $1,585.22 / $1,596.74
| Professional | | $1,194.96 | $1,585.22 | $1,596.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,301.00 / $5,511.00 / $11,083.00
| Facility | | $1,301.00 | $5,511.00 | $11,083.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $914.48 / $1,071.47 / $5,385.82
| Professional | | $914.48 | $1,071.47 | $5,385.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $1,248.50 / $2,654.30
| Professional | | $5.00 | $1,248.50 | $2,654.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $979.88 / $1,316.39 / $2,206.65
| Professional | | $979.88 | $1,316.39 | $2,206.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,001.30 / $1,001.30 / $1,135.59
| Facility | | $1,001.30 | $1,001.30 | $1,135.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $976.08 / $1,001.30 / $1,135.59
| Professional | | $976.08 | $1,001.30 | $1,135.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $3,914.00 / $7,000.00
| Facility | | $2,332.00 | $3,914.00 | $7,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $911.81 / $1,282.67 / $2,013.59
| Professional | | $911.81 | $1,282.67 | $2,013.59 |