- 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
- $942.22 / $1,113.30 / $1,299.17
| Professional | | $942.22 | $1,113.30 | $1,299.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.91 / $11,851.00 / $28,970.26
| Facility | | $8,639.91 | $11,851.00 | $28,970.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $817.04 / $1,210.79 / $1,758.22
| Professional | | $817.04 | $1,210.79 | $1,758.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $908.29 / $1,240.98 / $1,922.46
| Professional | | $908.29 | $1,240.98 | $1,922.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,405.14 / $1,405.14 / $1,488.93
| Professional | | $1,405.14 | $1,405.14 | $1,488.93 |
- 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
- $942.22 / $1,152.90 / $4,749.67
| Professional | | $942.22 | $1,152.90 | $4,749.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $1,672.70 / $2,286.00
| Professional | | $3.00 | $1,672.70 | $2,286.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $961.23 / $1,254.94 / $2,070.40
| Professional | | $961.23 | $1,254.94 | $2,070.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $906.82 / $906.82 / $1,212.02
| Facility | | $906.82 | $906.82 | $1,212.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $864.41 / $924.96 / $1,212.02
| Professional | | $864.41 | $924.96 | $1,212.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $4,765.24 / $10,130.54
| Facility | | $2,332.00 | $4,765.24 | $10,130.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $917.53 / $1,210.69 / $1,906.88
| Professional | | $917.53 | $1,210.69 | $1,906.88 |