- 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
- $1,264.16 / $1,448.57 / $1,917.11
| Professional | | $1,264.16 | $1,448.57 | $1,917.11 |
- 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
- $1,422.30 / $1,475.97 / $1,475.97
| Professional | | $1,422.30 | $1,475.97 | $1,475.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,376.19 / $1,903.55 / $3,021.93
| Professional | | $1,376.19 | $1,903.55 | $3,021.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,709.85 / $2,291.02 / $2,291.02
| Professional | | $1,709.85 | $2,291.02 | $2,291.02 |
- 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
- $1,264.16 / $1,476.97 / $3,690.02
| Professional | | $1,264.16 | $1,476.97 | $3,690.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.00 / $1,935.80 / $3,547.00
| Professional | | $17.00 | $1,935.80 | $3,547.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,435.98 / $1,936.26 / $3,302.86
| Professional | | $1,435.98 | $1,936.26 | $3,302.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,392.99 / $1,392.99 / $1,609.46
| Facility | | $1,392.99 | $1,392.99 | $1,609.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,332.72 / $1,417.76 / $1,609.46
| Professional | | $1,332.72 | $1,417.76 | $1,609.46 |
- 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
- $1,307.97 / $1,758.60 / $2,904.34
| Professional | | $1,307.97 | $1,758.60 | $2,904.34 |