- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,007.25 / $3,839.00 / $8,427.00
| Facility | | $1,007.25 | $3,839.00 | $8,427.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $836.99 / $951.60 / $1,198.60
| Professional | | $836.99 | $951.60 | $1,198.60 |
- 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
- $832.97 / $1,325.14 / $1,774.17
| Professional | | $832.97 | $1,325.14 | $1,774.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,695.80 / $3,906.17 / $4,680.04
| Professional | | $3,695.80 | $3,906.17 | $4,680.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,099.35 / $1,454.51 / $1,459.38
| Professional | | $1,099.35 | $1,454.51 | $1,459.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,007.25 / $4,761.00 / $8,427.00
| Facility | | $1,007.25 | $4,761.00 | $8,427.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $836.99 / $1,001.89 / $2,429.05
| Professional | | $836.99 | $1,001.89 | $2,429.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $1,188.90 / $2,341.10
| Professional | | $6.00 | $1,188.90 | $2,341.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,695.80 / $3,906.17 / $4,680.04
| Professional | | $3,695.80 | $3,906.17 | $4,680.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $916.82 / $916.82 / $1,098.18
| Facility | | $916.82 | $916.82 | $1,098.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $888.93 / $921.41 / $1,098.18
| Professional | | $888.93 | $921.41 | $1,098.18 |
- 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
- $886.73 / $1,164.36 / $1,902.87
| Professional | | $886.73 | $1,164.36 | $1,902.87 |