- 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
- $955.88 / $1,072.00 / $1,307.32
| Professional | | $955.88 | $1,072.00 | $1,307.32 |
- 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
- $820.62 / $1,221.50 / $1,775.01
| Professional | | $820.62 | $1,221.50 | $1,775.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $910.45 / $1,263.60 / $1,932.58
| Professional | | $910.45 | $1,263.60 | $1,932.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,406.88 / $1,406.88 / $1,494.55
| Professional | | $1,406.88 | $1,406.88 | $1,494.55 |
- 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
- $903.09 / $1,155.60 / $4,773.78
| Professional | | $903.09 | $1,155.60 | $4,773.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $1,703.60 / $2,289.69
| Professional | | $10.00 | $1,703.60 | $2,289.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $972.01 / $1,286.99 / $1,976.93
| Professional | | $972.01 | $1,286.99 | $1,976.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $911.60 / $911.60 / $1,450.05
| Facility | | $911.60 | $911.60 | $1,450.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $868.12 / $929.83 / $1,450.05
| Professional | | $868.12 | $929.83 | $1,450.05 |
- 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
- $921.55 / $1,244.64 / $1,922.57
| Professional | | $921.55 | $1,244.64 | $1,922.57 |