- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $3,839.00 / $8,247.00
| Facility | | $1,020.00 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,042.15 / $1,206.26 / $1,513.66
| Professional | | $1,042.15 | $1,206.26 | $1,513.66 |
- 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
- $1,190.45 / $1,235.38 / $1,235.38
| Professional | | $1,190.45 | $1,235.38 | $1,235.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.95 / $1,536.36 / $2,421.07
| Professional | | $1,148.95 | $1,536.36 | $2,421.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,384.38 / $1,831.45 / $1,836.66
| Professional | | $1,384.38 | $1,831.45 | $1,836.66 |
- 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
- $1,047.58 / $1,217.03 / $3,062.47
| Professional | | $1,047.58 | $1,217.03 | $3,062.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $1,557.80 / $2,950.40
| Professional | | $6.00 | $1,557.80 | $2,950.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,164.26 / $1,552.81 / $2,476.44
| Professional | | $1,164.26 | $1,552.81 | $2,476.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.26 / $1,157.26 / $1,471.65
| Facility | | $1,157.26 | $1,157.26 | $1,471.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,121.58 / $1,163.56 / $1,471.65
| Professional | | $1,121.58 | $1,163.56 | $1,471.65 |
- 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
- $1,119.29 / $1,460.14 / $2,415.65
| Professional | | $1,119.29 | $1,460.14 | $2,415.65 |