- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,019.86 / $3,839.00 / $8,247.00
| Facility | | $1,019.86 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,019.86 / $1,146.31 / $1,461.14
| Professional | | $1,019.86 | $1,146.31 | $1,461.14 |
- 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
- $1,013.66 / $1,192.54 / $1,945.97
| Professional | | $1,013.66 | $1,192.54 | $1,945.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,109.19 / $1,484.30 / $2,338.82
| Professional | | $1,109.19 | $1,484.30 | $2,338.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,335.68 / $1,766.93 / $1,771.61
| Professional | | $1,335.68 | $1,766.93 | $1,771.61 |
- 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
- $1,019.86 / $1,217.54 / $2,953.37
| Professional | | $1,019.86 | $1,217.54 | $2,953.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $1,489.80 / $2,844.90
| Professional | | $7.00 | $1,489.80 | $2,844.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,124.25 / $1,499.07 / $2,404.46
| Professional | | $1,124.25 | $1,499.07 | $2,404.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,117.06 / $1,117.06 / $1,464.70
| Facility | | $1,117.06 | $1,117.06 | $1,464.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,082.58 / $1,123.19 / $1,464.70
| Professional | | $1,082.58 | $1,123.19 | $1,464.70 |
- 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
- $1,081.93 / $1,424.51 / $2,344.73
| Professional | | $1,081.93 | $1,424.51 | $2,344.73 |