- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $3,839.00 / $8,247.00
| Facility | | $1,013.00 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $956.95 / $1,080.26 / $1,398.47
| Professional | | $956.95 | $1,080.26 | $1,398.47 |
- 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
- $955.88 / $1,529.82 / $2,002.36
| Professional | | $955.88 | $1,529.82 | $2,002.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,032.75 / $1,375.17 / $2,202.90
| Professional | | $1,032.75 | $1,375.17 | $2,202.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,309.85 / $1,754.64 / $1,754.64
| Professional | | $1,309.85 | $1,754.64 | $1,754.64 |
- 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
- $956.95 / $1,164.10 / $2,843.00
| Professional | | $956.95 | $1,164.10 | $2,843.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $1,280.00 / $2,733.80
| Professional | | $15.00 | $1,280.00 | $2,733.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,073.45 / $1,398.52 / $2,243.46
| Professional | | $1,073.45 | $1,398.52 | $2,243.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,058.42 / $1,058.42 / $1,070.15
| Facility | | $1,058.42 | $1,058.42 | $1,070.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,015.28 / $1,070.15 / $1,115.65
| Professional | | $1,015.28 | $1,070.15 | $1,115.65 |
- 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
- $962.21 / $1,328.86 / $2,340.76
| Professional | | $962.21 | $1,328.86 | $2,340.76 |