- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,299.19 / $4,304.00 / $8,240.00
| Facility | | $1,299.19 | $4,304.00 | $8,240.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $909.49 / $1,222.20 / $1,593.82
| Professional | | $909.49 | $1,222.20 | $1,593.82 |
- 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
- $1,197.56 / $1,242.75 / $1,242.75
| Professional | | $1,197.56 | $1,242.75 | $1,242.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $911.62 / $1,380.05 / $2,269.79
| Professional | | $911.62 | $1,380.05 | $2,269.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,429.07 / $1,895.80 / $1,913.43
| Professional | | $1,429.07 | $1,895.80 | $1,913.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $4,761.00 / $8,247.00
| Facility | | $1,020.00 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $909.49 / $1,272.64 / $4,831.00
| Professional | | $909.49 | $1,272.64 | $4,831.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $1,163.40 / $3,142.00
| Professional | | $6.00 | $1,163.40 | $3,142.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.75 / $1,430.56 / $2,326.79
| Professional | | $1,028.75 | $1,430.56 | $2,326.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $979.13 / $1,182.28 / $1,182.28
| Facility | | $979.13 | $1,182.28 | $1,182.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $979.13 / $1,182.28 / $1,256.76
| Professional | | $979.13 | $1,182.28 | $1,256.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,197.00 / $3,879.00 / $7,000.00
| Facility | | $2,197.00 | $3,879.00 | $7,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $947.56 / $1,357.89 / $2,363.31
| Professional | | $947.56 | $1,357.89 | $2,363.31 |