- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,105.05 / $5,254.00 / $10,398.00
| Facility | | $1,105.05 | $5,254.00 | $10,398.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $918.78 / $1,099.50 / $1,353.75
| Professional | | $918.78 | $1,099.50 | $1,353.75 |
- 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
- $1,035.61 / $1,074.70 / $1,074.70
| Professional | | $1,035.61 | $1,074.70 | $1,074.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $999.25 / $1,343.41 / $2,119.98
| Professional | | $999.25 | $1,343.41 | $2,119.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,204.76 / $1,593.82 / $1,598.90
| Professional | | $1,204.76 | $1,593.82 | $1,598.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,301.00 / $5,526.00 / $11,083.00
| Facility | | $1,301.00 | $5,526.00 | $11,083.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $918.78 / $1,120.40 / $5,481.44
| Professional | | $918.78 | $1,120.40 | $5,481.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $1,322.30 / $2,567.40
| Professional | | $6.00 | $1,322.30 | $2,567.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,011.57 / $1,350.48 / $2,183.53
| Professional | | $1,011.57 | $1,350.48 | $2,183.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,007.03 / $1,007.03 / $1,198.59
| Facility | | $1,007.03 | $1,007.03 | $1,198.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $976.13 / $1,012.36 / $1,198.59
| Professional | | $976.13 | $1,012.36 | $1,198.59 |
- 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
- $1,024.67 / $1,285.28 / $2,099.44
| Professional | | $1,024.67 | $1,285.28 | $2,099.44 |