- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,301.00 / $3,964.00 / $8,451.00
| Facility | | $1,301.00 | $3,964.00 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,519.47 / $1,710.54 / $2,144.67
| Professional | | $1,519.47 | $1,710.54 | $2,144.67 |
- 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
- $1,533.80 / $1,591.68 / $1,591.68
| Professional | | $1,533.80 | $1,591.68 | $1,591.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,519.33 / $1,989.38 / $3,112.43
| Professional | | $1,519.33 | $1,989.38 | $3,112.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,348.90 / $2,348.90 / $2,455.38
| Professional | | $2,348.90 | $2,348.90 | $2,455.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $5,342.00 / $8,990.00
| Facility | | $1,013.00 | $5,342.00 | $8,990.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,426.00 / $1,854.64 / $5,958.00
| Professional | | $1,426.00 | $1,854.64 | $5,958.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.00 / $2,799.70 / $3,832.90
| Professional | | $20.00 | $2,799.70 | $3,832.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,580.06 / $1,998.85 / $3,112.43
| Professional | | $1,580.06 | $1,998.85 | $3,112.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,504.13 / $1,504.13 / $2,369.92
| Facility | | $1,504.13 | $1,504.13 | $2,369.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,440.46 / $1,529.52 / $2,369.92
| Professional | | $1,440.46 | $1,529.52 | $2,369.92 |
- 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
- $1,464.84 / $1,947.37 / $3,094.69
| Professional | | $1,464.84 | $1,947.37 | $3,094.69 |