- 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
- $1,069.08 / $1,200.50 / $1,532.03
| Professional | | $1,069.08 | $1,200.50 | $1,532.03 |
- 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
- $1,061.51 / $1,692.44 / $2,271.57
| Professional | | $1,061.51 | $1,692.44 | $2,271.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,142.16 / $1,554.98 / $2,371.82
| Professional | | $1,142.16 | $1,554.98 | $2,371.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,398.05 / $1,849.31 / $1,854.29
| Professional | | $1,398.05 | $1,849.31 | $1,854.29 |
- 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
- $1,069.08 / $1,280.56 / $3,094.55
| Professional | | $1,069.08 | $1,280.56 | $3,094.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $1,435.70 / $2,980.50
| Professional | | $7.00 | $1,435.70 | $2,980.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,161.53 / $1,569.81 / $2,452.88
| Professional | | $1,161.53 | $1,569.81 | $2,452.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.94 / $1,170.94 / $1,467.53
| Facility | | $1,170.94 | $1,170.94 | $1,467.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,134.03 / $1,177.66 / $1,467.53
| Professional | | $1,134.03 | $1,177.66 | $1,467.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.00 / $2,391.00 / $6,322.00
| Facility | | $625.00 | $2,391.00 | $6,322.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,070.91 / $1,480.07 / $2,435.16
| Professional | | $1,070.91 | $1,480.07 | $2,435.16 |