- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,014.68 / $3,839.00 / $8,247.00
| Facility | | $1,014.68 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,014.68 / $1,140.28 / $1,453.77
| Professional | | $1,014.68 | $1,140.28 | $1,453.77 |
- 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
- $1,008.36 / $1,606.42 / $2,166.44
| Professional | | $1,008.36 | $1,606.42 | $2,166.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,103.33 / $1,476.38 / $2,325.98
| Professional | | $1,103.33 | $1,476.38 | $2,325.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,328.80 / $1,757.87 / $1,762.39
| Professional | | $1,328.80 | $1,757.87 | $1,762.39 |
- 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
- $1,014.68 / $1,214.64 / $2,938.51
| Professional | | $1,014.68 | $1,214.64 | $2,938.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $1,558.10 / $2,830.60
| Professional | | $7.00 | $1,558.10 | $2,830.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,117.38 / $1,491.17 / $2,459.11
| Professional | | $1,117.38 | $1,491.17 | $2,459.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,111.42 / $1,111.42 / $1,434.25
| Facility | | $1,111.42 | $1,111.42 | $1,434.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,077.10 / $1,117.53 / $1,434.25
| Professional | | $1,077.10 | $1,117.53 | $1,434.25 |
- 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
- $1,092.59 / $1,390.87 / $2,310.59
| Professional | | $1,092.59 | $1,390.87 | $2,310.59 |