- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,003.76 / $3,839.00 / $8,247.00
| Facility | | $1,003.76 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.87 / $922.01 / $1,154.20
| Professional | | $816.87 | $922.01 | $1,154.20 |
- 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
- $830.31 / $861.64 / $861.64
| Professional | | $830.31 | $861.64 | $861.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $826.50 / $1,074.03 / $1,684.49
| Professional | | $826.50 | $1,074.03 | $1,684.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,285.66 / $1,285.66 / $1,332.28
| Professional | | $1,285.66 | $1,285.66 | $1,332.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,003.76 / $4,761.00 / $8,247.00
| Facility | | $1,003.76 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $779.04 / $1,003.76 / $4,297.29
| Professional | | $779.04 | $1,003.76 | $4,297.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $1,504.10 / $2,091.19
| Professional | | $15.00 | $1,504.10 | $2,091.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $856.49 / $1,083.18 / $1,684.49
| Professional | | $856.49 | $1,083.18 | $1,684.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.36 / $812.36 / $988.03
| Facility | | $812.36 | $812.36 | $988.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $780.61 / $823.32 / $988.03
| Professional | | $780.61 | $823.32 | $988.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.00 / $2,391.00 / $6,322.00
| Facility | | $656.00 | $2,391.00 | $6,322.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.66 / $1,065.06 / $1,656.62
| Professional | | $812.66 | $1,065.06 | $1,656.62 |