- 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
- $851.39 / $962.60 / $1,223.27
| Professional | | $851.39 | $962.60 | $1,223.27 |
- 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
- $833.27 / $1,349.84 / $1,791.01
| Professional | | $833.27 | $1,349.84 | $1,791.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $911.26 / $1,235.07 / $1,942.91
| Professional | | $911.26 | $1,235.07 | $1,942.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,099.73 / $1,454.97 / $1,459.87
| Professional | | $1,099.73 | $1,454.97 | $1,459.87 |
- 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
- $851.39 / $1,025.96 / $3,052.29
| Professional | | $851.39 | $1,025.96 | $3,052.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $1,192.50 / $2,382.30
| Professional | | $7.00 | $1,192.50 | $2,382.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $917.17 / $1,244.14 / $1,953.59
| Professional | | $917.17 | $1,244.14 | $1,953.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.91 / $933.91 / $1,064.32
| Facility | | $933.91 | $933.91 | $1,064.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $903.82 / $940.23 / $1,064.32
| Professional | | $903.82 | $940.23 | $1,064.32 |
- 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
- $909.17 / $1,145.54 / $1,929.09
| Professional | | $909.17 | $1,145.54 | $1,929.09 |