- 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
- $1,453.07 / $1,639.22 / $2,038.06
| Professional | | $1,453.07 | $1,639.22 | $2,038.06 |
- 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
- $1,161.66 / $1,889.05 / $2,757.34
| Professional | | $1,161.66 | $1,889.05 | $2,757.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,423.02 / $1,856.65 / $2,955.57
| Professional | | $1,423.02 | $1,856.65 | $2,955.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,986.38 / $1,986.38 / $2,115.16
| Professional | | $1,986.38 | $1,986.38 | $2,115.16 |
- 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
- $1,426.00 / $1,752.85 / $3,522.36
| Professional | | $1,426.00 | $1,752.85 | $3,522.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $1,228.30 / $3,643.00
| Professional | | $15.00 | $1,228.30 | $3,643.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,423.02 / $1,884.74 / $2,955.57
| Professional | | $1,423.02 | $1,884.74 | $2,955.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,319.16 / $1,430.16 / $1,430.16
| Facility | | $1,319.16 | $1,430.16 | $1,430.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,319.16 / $1,430.16 / $1,498.52
| Professional | | $1,319.16 | $1,430.16 | $1,498.52 |
- 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
- $1,347.92 / $1,801.51 / $2,876.99
| Professional | | $1,347.92 | $1,801.51 | $2,876.99 |