- 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
- $1,324.78 / $1,474.52 / $1,828.55
| Professional | | $1,324.78 | $1,474.52 | $1,828.55 |
- 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
- $1,147.88 / $1,712.44 / $2,534.82
| Professional | | $1,147.88 | $1,712.44 | $2,534.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,275.00 / $1,742.99 / $2,701.38
| Professional | | $1,275.00 | $1,742.99 | $2,701.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,963.72 / $1,963.72 / $2,090.55
| Professional | | $1,963.72 | $1,963.72 | $2,090.55 |
- 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
- $1,324.78 / $1,566.48 / $5,958.00
| Professional | | $1,324.78 | $1,566.48 | $5,958.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $1,431.90 / $3,192.60
| Professional | | $15.00 | $1,431.90 | $3,192.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,350.45 / $1,742.99 / $2,704.64
| Professional | | $1,350.45 | $1,742.99 | $2,704.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,274.24 / $1,274.24 / $1,301.79
| Facility | | $1,274.24 | $1,274.24 | $1,301.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,212.71 / $1,299.72 / $1,328.48
| Professional | | $1,212.71 | $1,299.72 | $1,328.48 |
- 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
- $1,237.73 / $1,741.93 / $2,729.65
| Professional | | $1,237.73 | $1,741.93 | $2,729.65 |