- 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
- $1,191.51 / $1,323.91 / $1,547.41
| Professional | | $1,191.51 | $1,323.91 | $1,547.41 |
- 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
- $971.07 / $1,450.49 / $2,106.91
| Professional | | $971.07 | $1,450.49 | $2,106.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,074.47 / $1,493.85 / $2,285.54
| Professional | | $1,074.47 | $1,493.85 | $2,285.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,660.13 / $1,660.13 / $1,768.19
| Professional | | $1,660.13 | $1,660.13 | $1,768.19 |
- 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
- $1,073.26 / $1,362.90 / $5,649.81
| Professional | | $1,073.26 | $1,362.90 | $5,649.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.00 / $1,612.80 / $2,807.50
| Professional | | $8.00 | $1,612.80 | $2,807.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,143.74 / $1,562.47 / $2,315.46
| Professional | | $1,143.74 | $1,562.47 | $2,315.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.08 / $1,078.08 / $1,170.25
| Facility | | $1,078.08 | $1,078.08 | $1,170.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,025.81 / $1,099.64 / $1,170.25
| Professional | | $1,025.81 | $1,099.64 | $1,170.25 |
- 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
- $1,057.25 / $1,472.48 / $2,312.94
| Professional | | $1,057.25 | $1,472.48 | $2,312.94 |