- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $958.15 / $3,839.00 / $8,247.00
| Facility | | $958.15 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $894.13 / $1,016.25 / $1,329.87
| Professional | | $894.13 | $1,016.25 | $1,329.87 |
- 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
- $1,067.93 / $1,108.23 / $1,108.23
| Professional | | $1,067.93 | $1,108.23 | $1,108.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,007.48 / $1,361.77 / $2,157.01
| Professional | | $1,007.48 | $1,361.77 | $2,157.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,261.86 / $1,677.58 / $1,677.58
| Professional | | $1,261.86 | $1,677.58 | $1,677.58 |
- 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
- $894.13 / $1,092.59 / $2,806.39
| Professional | | $894.13 | $1,092.59 | $2,806.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $1,141.70 / $2,706.70
| Professional | | $6.00 | $1,141.70 | $2,706.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,018.17 / $1,379.30 / $2,262.44
| Professional | | $1,018.17 | $1,379.30 | $2,262.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,054.44 / $1,054.44 / $1,147.29
| Facility | | $1,054.44 | $1,054.44 | $1,147.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,019.04 / $1,062.93 / $1,147.29
| Professional | | $1,019.04 | $1,062.93 | $1,147.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,222.00 / $3,475.00 / $6,000.00
| Facility | | $2,222.00 | $3,475.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.01 / $1,330.07 / $2,150.81
| Professional | | $977.01 | $1,330.07 | $2,150.81 |