- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,110.94 / $8,477.27 / $19,276.96
| Facility | | $1,110.94 | $8,477.27 | $19,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,110.94 / $1,229.01 / $5,950.60
| Professional | | $1,110.94 | $1,229.01 | $5,950.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,626.18 / $1,626.18 / $1,626.18
| Professional | | $1,626.18 | $1,626.18 | $1,626.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,860.00 / $10,338.04 / $19,997.13
| Facility | | $7,860.00 | $10,338.04 | $19,997.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,074.77 / $1,832.00 / $2,442.67
| Professional | | $1,074.77 | $1,832.00 | $2,442.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,717.60 / $12,717.60 / $12,717.60
| Facility | | $12,717.60 | $12,717.60 | $12,717.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,809.00 / $2,700.51 / $3,620.39
| Professional | | $1,809.00 | $2,700.51 | $3,620.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,110.94 / $1,999.69 / $9,696.00
| Facility | | $1,110.94 | $1,999.69 | $9,696.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,478.33 / $2,444.94 / $3,348.77
| Professional | | $1,478.33 | $2,444.94 | $3,348.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,418.05 / $2,996.49 / $16,108.96
| Facility | | $1,418.05 | $2,996.49 | $16,108.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,032.00 / $2,483.02 / $3,620.39
| Professional | | $2,032.00 | $2,483.02 | $3,620.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,196.95 / $2,211.60 / $17,710.68
| Professional | | $1,196.95 | $2,211.60 | $17,710.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,478.33 / $2,497.98 / $3,254.80
| Professional | | $1,478.33 | $2,497.98 | $3,254.80 |