- 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
- $1,447.73 / $1,616.29 / $2,066.77
| Professional | | $1,447.73 | $1,616.29 | $2,066.77 |
- 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
- $1,250.93 / $1,893.65 / $2,732.30
| Professional | | $1,250.93 | $1,893.65 | $2,732.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,398.08 / $1,857.46 / $2,885.27
| Professional | | $1,398.08 | $1,857.46 | $2,885.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,148.65 / $2,148.65 / $2,277.63
| Professional | | $2,148.65 | $2,148.65 | $2,277.63 |
- 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 / $1,728.04 / $5,106.26
| Professional | | $1,426.00 | $1,728.04 | $5,106.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $2,209.00 / $3,518.60
| Professional | | $15.00 | $2,209.00 | $3,518.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,471.68 / $1,867.00 / $2,885.27
| Professional | | $1,471.68 | $1,867.00 | $2,885.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,405.58 / $1,405.58 / $1,527.98
| Facility | | $1,405.58 | $1,405.58 | $1,527.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,340.14 / $1,433.69 / $1,527.98
| Professional | | $1,340.14 | $1,433.69 | $1,527.98 |
- 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
- $1,358.80 / $1,800.55 / $2,945.64
| Professional | | $1,358.80 | $1,800.55 | $2,945.64 |