- 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
- $902.23 / $1,073.76 / $1,201.43
| Professional | | $902.23 | $1,073.76 | $1,201.43 |
- 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
- $845.85 / $995.12 / $1,544.46
| Professional | | $845.85 | $995.12 | $1,544.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $942.70 / $1,286.38 / $1,998.93
| Professional | | $942.70 | $1,286.38 | $1,998.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,459.90 / $1,459.90 / $1,532.31
| Professional | | $1,459.90 | $1,459.90 | $1,532.31 |
- 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
- $849.52 / $1,147.73 / $2,295.46
| Professional | | $849.52 | $1,147.73 | $2,295.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,377.60 / $2,377.60 / $2,377.60
| Professional | | $2,377.60 | $2,377.60 | $2,377.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,026.91 / $1,334.98 / $2,100.42
| Professional | | $1,026.91 | $1,334.98 | $2,100.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $942.89 / $942.89 / $1,053.38
| Facility | | $942.89 | $942.89 | $1,053.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $901.41 / $960.43 / $1,053.38
| Professional | | $901.41 | $960.43 | $1,053.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.00 / $2,391.00 / $6,228.00
| Facility | | $656.00 | $2,391.00 | $6,228.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $953.13 / $1,283.64 / $1,989.42
| Professional | | $953.13 | $1,283.64 | $1,989.42 |