- 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
- $1,597.41 / $1,792.66 / $2,231.27
| Professional | | $1,597.41 | $1,792.66 | $2,231.27 |
- 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
- $1,409.44 / $2,114.42 / $3,053.61
| Professional | | $1,409.44 | $2,114.42 | $3,053.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,582.39 / $2,072.91 / $3,242.21
| Professional | | $1,582.39 | $2,072.91 | $3,242.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,447.71 / $2,447.71 / $2,558.41
| Professional | | $2,447.71 | $2,447.71 | $2,558.41 |
- 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
- $1,426.00 / $1,931.98 / $5,958.00
| Professional | | $1,426.00 | $1,931.98 | $5,958.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $1,979.10 / $3,538.40
| Professional | | $15.00 | $1,979.10 | $3,538.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,591.52 / $2,082.27 / $3,242.21
| Professional | | $1,591.52 | $2,082.27 | $3,242.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,395.11 / $1,565.25 / $1,565.25
| Facility | | $1,395.11 | $1,565.25 | $1,565.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,395.11 / $1,565.25 / $1,640.08
| Professional | | $1,395.11 | $1,565.25 | $1,640.08 |
- 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
- $1,508.75 / $2,008.74 / $3,223.06
| Professional | | $1,508.75 | $2,008.74 | $3,223.06 |