- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $3,839.00 / $8,247.00
| Facility | | $1,020.00 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $988.33 / $1,072.57 / $1,451.20
| Professional | | $988.33 | $1,072.57 | $1,451.20 |
- 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
- $1,077.08 / $1,666.68 / $2,248.57
| Professional | | $1,077.08 | $1,666.68 | $2,248.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,020.51 / $1,529.83 / $2,590.00
| Professional | | $1,020.51 | $1,529.83 | $2,590.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.80 / $1,980.96 / $1,980.96
| Professional | | $1,479.80 | $1,980.96 | $1,980.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.00 / $4,761.00 / $8,247.00
| Facility | | $832.00 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,026.65 / $1,134.97 / $3,226.88
| Professional | | $1,026.65 | $1,134.97 | $3,226.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,196.30 / $1,704.90 / $2,523.48
| Professional | | $1,196.30 | $1,704.90 | $2,523.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,179.30 / $1,551.57 / $2,590.00
| Professional | | $1,179.30 | $1,551.57 | $2,590.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,193.55 / $1,193.55 / $1,195.63
| Facility | | $1,193.55 | $1,193.55 | $1,195.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.56 / $1,195.63 / $1,262.46
| Professional | | $1,148.56 | $1,195.63 | $1,262.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.00 / $2,391.00 / $6,322.00
| Facility | | $625.00 | $2,391.00 | $6,322.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $961.85 / $1,485.10 / $2,464.81
| Professional | | $961.85 | $1,485.10 | $2,464.81 |