- 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
- $863.69 / $984.56 / $1,586.38
| Professional | | $863.69 | $984.56 | $1,586.38 |
- 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
- $1,019.13 / $1,057.58 / $1,057.58
| Professional | | $1,019.13 | $1,057.58 | $1,057.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $961.44 / $1,297.95 / $2,127.01
| Professional | | $961.44 | $1,297.95 | $2,127.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,274.00 / $1,721.76 / $1,721.76
| Professional | | $1,274.00 | $1,721.76 | $1,721.76 |
- 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
- $866.53 / $1,056.78 / $3,081.67
| Professional | | $866.53 | $1,056.78 | $3,081.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.00 / $992.80 / $2,550.19
| Professional | | $11.00 | $992.80 | $2,550.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $983.85 / $1,288.76 / $2,130.89
| Professional | | $983.85 | $1,288.76 | $2,130.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $807.65 / $989.31 / $989.31
| Facility | | $807.65 | $989.31 | $989.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $807.65 / $989.31 / $1,053.44
| Professional | | $807.65 | $989.31 | $1,053.44 |
- 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
- $936.41 / $1,332.28 / $2,019.15
| Professional | | $936.41 | $1,332.28 | $2,019.15 |