- 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
- $942.65 / $1,123.77 / $1,512.43
| Professional | | $942.65 | $1,123.77 | $1,512.43 |
- 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
- $1,129.02 / $1,171.61 / $1,171.61
| Professional | | $1,129.02 | $1,171.61 | $1,171.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,090.84 / $1,459.36 / $2,336.66
| Professional | | $1,090.84 | $1,459.36 | $2,336.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,360.65 / $1,821.63 / $1,821.63
| Professional | | $1,360.65 | $1,821.63 | $1,821.63 |
- 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
- $942.65 / $1,143.92 / $1,916.68
| Professional | | $942.65 | $1,143.92 | $1,916.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $1,281.20 / $2,830.10
| Professional | | $15.00 | $1,281.20 | $2,830.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,090.84 / $1,474.28 / $2,406.42
| Professional | | $1,090.84 | $1,474.28 | $2,406.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $955.10 / $1,102.20 / $1,102.20
| Facility | | $955.10 | $1,102.20 | $1,102.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $955.10 / $1,102.20 / $1,160.20
| Professional | | $955.10 | $1,102.20 | $1,160.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.00 / $2,391.00 / $6,228.00
| Facility | | $625.00 | $2,391.00 | $6,228.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $967.80 / $1,384.64 / $2,286.15
| Professional | | $967.80 | $1,384.64 | $2,286.15 |