- 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
- $1,002.06 / $1,125.24 / $1,332.66
| Professional | | $1,002.06 | $1,125.24 | $1,332.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,431.95 / $7,827.00 / $19,139.18
| Facility | | $6,431.95 | $7,827.00 | $19,139.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $948.83 / $984.63 / $984.63
| Professional | | $948.83 | $984.63 | $984.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $927.88 / $1,290.39 / $1,994.58
| Professional | | $927.88 | $1,290.39 | $1,994.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,434.31 / $1,434.31 / $1,524.46
| Professional | | $1,434.31 | $1,434.31 | $1,524.46 |
- 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
- $1,002.06 / $1,143.39 / $4,867.05
| Professional | | $1,002.06 | $1,143.39 | $4,867.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $1,261.30 / $2,333.30
| Professional | | $6.00 | $1,261.30 | $2,333.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $986.59 / $1,299.30 / $2,002.33
| Professional | | $986.59 | $1,299.30 | $2,002.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $929.20 / $929.20 / $976.75
| Facility | | $929.20 | $929.20 | $976.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $884.82 / $947.78 / $976.75
| Professional | | $884.82 | $947.78 | $976.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,440.00 / $3,475.00 / $6,000.00
| Facility | | $1,440.00 | $3,475.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $940.04 / $1,286.41 / $2,014.42
| Professional | | $940.04 | $1,286.41 | $2,014.42 |