- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $3,839.00 / $8,247.00
| Facility | | $1,013.00 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $853.94 / $970.67 / $1,351.01
| Professional | | $853.94 | $970.67 | $1,351.01 |
- 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
- $886.79 / $1,043.28 / $1,703.13
| Professional | | $886.79 | $1,043.28 | $1,703.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $953.61 / $1,280.40 / $2,101.87
| Professional | | $953.61 | $1,280.40 | $2,101.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,257.28 / $1,700.56 / $1,700.56
| Professional | | $1,257.28 | $1,700.56 | $1,700.56 |
- 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
- $853.94 / $1,024.86 / $2,843.00
| Professional | | $853.94 | $1,024.86 | $2,843.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.00 / $975.30 / $2,510.19
| Professional | | $9.00 | $975.30 | $2,510.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $970.78 / $1,280.40 / $2,122.75
| Professional | | $970.78 | $1,280.40 | $2,122.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $811.34 / $977.61 / $977.61
| Facility | | $811.34 | $977.61 | $977.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $811.34 / $977.61 / $1,039.65
| Professional | | $811.34 | $977.61 | $1,039.65 |
- 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
- $977.84 / $1,293.79 / $1,982.86
| Professional | | $977.84 | $1,293.79 | $1,982.86 |