- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.19 / $5,350.00 / $13,947.00
| Facility | | $1,061.19 | $5,350.00 | $13,947.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $874.40 / $976.42 / $1,222.79
| Professional | | $874.40 | $976.42 | $1,222.79 |
- 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
- $879.04 / $912.21 / $912.21
| Professional | | $879.04 | $912.21 | $912.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $872.38 / $1,146.28 / $1,780.86
| Professional | | $872.38 | $1,146.28 | $1,780.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,356.88 / $1,356.88 / $1,409.95
| Professional | | $1,356.88 | $1,356.88 | $1,409.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $5,526.00 / $13,969.00
| Facility | | $1,020.00 | $5,526.00 | $13,969.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $830.51 / $1,061.19 / $4,555.16
| Professional | | $830.51 | $1,061.19 | $4,555.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $1,465.80 / $2,205.60
| Professional | | $15.00 | $1,465.80 | $2,205.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $901.68 / $1,158.72 / $1,780.86
| Professional | | $901.68 | $1,158.72 | $1,780.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $859.70 / $859.70 / $944.36
| Facility | | $859.70 | $859.70 | $944.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $825.24 / $872.19 / $944.36
| Professional | | $825.24 | $872.19 | $944.36 |
- 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
- $822.26 / $1,055.45 / $1,755.01
| Professional | | $822.26 | $1,055.45 | $1,755.01 |