- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $3,839.00 / $8,427.00
| Facility | | $1,020.00 | $3,839.00 | $8,427.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $853.37 / $1,023.11 / $1,279.89
| Professional | | $853.37 | $1,023.11 | $1,279.89 |
- 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
- $809.00 / $1,469.73 / $1,948.80
| Professional | | $809.00 | $1,469.73 | $1,948.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $908.34 / $1,273.16 / $1,878.16
| Professional | | $908.34 | $1,273.16 | $1,878.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,408.72 / $1,408.72 / $1,477.38
| Professional | | $1,408.72 | $1,408.72 | $1,477.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $4,761.00 / $8,427.00
| Facility | | $1,013.00 | $4,761.00 | $8,427.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $853.37 / $1,104.86 / $4,751.67
| Professional | | $853.37 | $1,104.86 | $4,751.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $1,527.90 / $2,288.00
| Professional | | $15.00 | $1,527.90 | $2,288.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $986.10 / $1,275.00 / $1,878.16
| Professional | | $986.10 | $1,275.00 | $1,878.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $897.27 / $897.27 / $1,003.99
| Facility | | $897.27 | $897.27 | $1,003.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $858.92 / $912.74 / $1,003.99
| Professional | | $858.92 | $912.74 | $1,003.99 |
- 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
- $929.28 / $1,238.25 / $2,033.17
| Professional | | $929.28 | $1,238.25 | $2,033.17 |