- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,011.14 / $3,839.00 / $8,247.00
| Facility | | $1,011.14 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $840.44 / $944.93 / $1,203.60
| Professional | | $840.44 | $944.93 | $1,203.60 |
- 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
- $836.34 / $1,330.57 / $1,782.31
| Professional | | $836.34 | $1,330.57 | $1,782.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $914.64 / $1,223.19 / $1,924.67
| Professional | | $914.64 | $1,223.19 | $1,924.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,103.59 / $1,460.14 / $1,464.63
| Professional | | $1,103.59 | $1,460.14 | $1,464.63 |
- 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
- $840.44 / $1,005.53 / $2,843.00
| Professional | | $840.44 | $1,005.53 | $2,843.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $1,212.40 / $2,349.69
| Professional | | $7.00 | $1,212.40 | $2,349.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.24 / $1,236.14 / $1,982.60
| Professional | | $924.24 | $1,236.14 | $1,982.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $920.58 / $920.58 / $1,088.58
| Facility | | $920.58 | $920.58 | $1,088.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $892.53 / $925.25 / $1,088.58
| Professional | | $892.53 | $925.25 | $1,088.58 |
- 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
- $884.56 / $1,179.26 / $1,910.51
| Professional | | $884.56 | $1,179.26 | $1,910.51 |