- 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
- $1,330.52 / $1,665.18 / $2,113.98
| Professional | | $1,330.52 | $1,665.18 | $2,113.98 |
- 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
- $1,509.59 / $1,566.55 / $2,436.53
| Professional | | $1,509.59 | $1,566.55 | $2,436.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,487.10 / $1,937.18 / $3,056.73
| Professional | | $1,487.10 | $1,937.18 | $3,056.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,309.92 / $2,309.92 / $2,430.27
| Professional | | $2,309.92 | $2,309.92 | $2,430.27 |
- 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
- $1,330.52 / $1,811.61 / $5,958.00
| Professional | | $1,330.52 | $1,811.61 | $5,958.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.00 / $2,891.70 / $3,762.20
| Professional | | $25.00 | $2,891.70 | $3,762.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,522.84 / $1,953.32 / $3,056.73
| Professional | | $1,522.84 | $1,953.32 | $3,056.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,480.24 / $1,480.24 / $2,141.25
| Facility | | $1,480.24 | $1,480.24 | $2,141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,415.34 / $1,507.46 / $2,141.25
| Professional | | $1,415.34 | $1,507.46 | $2,141.25 |
- 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
- $1,495.35 / $1,960.76 / $3,031.41
| Professional | | $1,495.35 | $1,960.76 | $3,031.41 |