- 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
- $912.95 / $1,024.17 / $1,315.14
| Professional | | $912.95 | $1,024.17 | $1,315.14 |
- 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
- $1,018.60 / $1,057.03 / $1,057.03
| Professional | | $1,018.60 | $1,057.03 | $1,057.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $969.50 / $1,323.01 / $2,077.44
| Professional | | $969.50 | $1,323.01 | $2,077.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,201.76 / $1,597.63 / $1,597.63
| Professional | | $1,201.76 | $1,597.63 | $1,597.63 |
- 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
- $912.95 / $1,090.91 / $2,843.00
| Professional | | $912.95 | $1,090.91 | $2,843.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $1,261.40 / $2,555.80
| Professional | | $6.00 | $1,261.40 | $2,555.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $988.58 / $1,336.07 / $2,192.75
| Professional | | $988.58 | $1,336.07 | $2,192.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,001.72 / $1,001.72 / $1,004.53
| Facility | | $1,001.72 | $1,001.72 | $1,004.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $967.26 / $1,004.53 / $1,050.54
| Professional | | $967.26 | $1,004.53 | $1,050.54 |
- 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
- $965.33 / $1,263.41 / $2,104.67
| Professional | | $965.33 | $1,263.41 | $2,104.67 |