- 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
- $870.39 / $977.69 / $1,244.96
| Professional | | $870.39 | $977.69 | $1,244.96 |
- 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
- $864.88 / $1,376.38 / $1,934.89
| Professional | | $864.88 | $1,376.38 | $1,934.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $946.36 / $1,278.13 / $1,991.73
| Professional | | $946.36 | $1,278.13 | $1,991.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,140.76 / $1,509.07 / $1,514.54
| Professional | | $1,140.76 | $1,509.07 | $1,514.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,303.36 / $1,303.36 / $1,303.36
| Facility | | $1,303.36 | $1,303.36 | $1,303.36 |
- 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
- $870.39 / $1,040.09 / $2,843.00
| Professional | | $870.39 | $1,040.09 | $2,843.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $1,246.09 / $2,433.19
| Professional | | $7.00 | $1,246.09 | $2,433.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $971.25 / $1,283.13 / $2,065.33
| Professional | | $971.25 | $1,283.13 | $2,065.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $952.26 / $952.26 / $1,165.20
| Facility | | $952.26 | $952.26 | $1,165.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $923.29 / $957.04 / $1,165.20
| Professional | | $923.29 | $957.04 | $1,165.20 |
- 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
- $961.04 / $1,193.57 / $1,976.10
| Professional | | $961.04 | $1,193.57 | $1,976.10 |