- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $5,254.00 / $10,398.00
| Facility | | $1,013.00 | $5,254.00 | $10,398.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $827.15 / $901.56 / $1,177.82
| Professional | | $827.15 | $901.56 | $1,177.82 |
- 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
- $802.14 / $1,308.59 / $1,763.32
| Professional | | $802.14 | $1,308.59 | $1,763.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $877.57 / $1,194.05 / $1,870.87
| Professional | | $877.57 | $1,194.05 | $1,870.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,080.59 / $1,433.30 / $1,442.40
| Professional | | $1,080.59 | $1,433.30 | $1,442.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,937.21 / $13,937.21 / $13,937.21
| Facility | | $13,937.21 | $13,937.21 | $13,937.21 |
- 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
- $827.15 / $969.66 / $4,870.39
| Professional | | $827.15 | $969.66 | $4,870.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $1,159.20 / $2,391.80
| Professional | | $5.00 | $1,159.20 | $2,391.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $887.48 / $1,194.05 / $1,999.04
| Professional | | $887.48 | $1,194.05 | $1,999.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $905.67 / $905.67 / $1,196.44
| Facility | | $905.67 | $905.67 | $1,196.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $882.59 / $905.68 / $1,196.44
| Professional | | $882.59 | $905.68 | $1,196.44 |
- 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
- $814.98 / $1,123.40 / $1,804.56
| Professional | | $814.98 | $1,123.40 | $1,804.56 |