- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,098.47 / $3,964.00 / $8,451.00
| Facility | | $1,098.47 | $3,964.00 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $863.14 / $1,098.47 / $1,829.23
| Professional | | $863.14 | $1,098.47 | $1,829.23 |
- 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
- $1,069.97 / $1,698.99 / $2,220.48
| Professional | | $1,069.97 | $1,698.99 | $2,220.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $958.02 / $1,428.72 / $2,414.12
| Professional | | $958.02 | $1,428.72 | $2,414.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,516.65 / $2,049.71 / $2,049.71
| Professional | | $1,516.65 | $2,049.71 | $2,049.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $5,342.00 / $8,451.00
| Facility | | $1,013.00 | $5,342.00 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $863.15 / $1,234.60 / $3,037.14
| Professional | | $863.15 | $1,234.60 | $3,037.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.00 / $1,135.30 / $3,035.50
| Professional | | $11.00 | $1,135.30 | $3,035.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $958.02 / $1,428.72 / $2,414.12
| Professional | | $958.02 | $1,428.72 | $2,414.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,087.78 / $1,177.61 / $1,177.61
| Facility | | $1,087.78 | $1,177.61 | $1,177.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,087.78 / $1,177.61 / $1,254.14
| Professional | | $1,087.78 | $1,177.61 | $1,254.14 |
- 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
- $1,018.64 / $1,557.92 / $2,366.07
| Professional | | $1,018.64 | $1,557.92 | $2,366.07 |