- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $934.33 / $1,048.55 / $21,879.00
| Facility | | $934.33 | $1,048.55 | $21,879.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $863.34 / $1,048.55 / $2,406.77
| Professional | | $863.34 | $1,048.55 | $2,406.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $8,639.91 / $79,506.39
| Facility | | $5,000.00 | $8,639.91 | $79,506.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $909.63 / $1,447.18 / $1,941.48
| Professional | | $909.63 | $1,447.18 | $1,941.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $839.07 / $1,264.72 / $2,081.31
| Professional | | $839.07 | $1,264.72 | $2,081.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.82 / $1,742.99 / $1,742.99
| Professional | | $1,288.82 | $1,742.99 | $1,742.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,048.55 / $21,879.00 / $23,354.00
| Facility | | $1,048.55 | $21,879.00 | $23,354.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $874.05 / $1,389.38 / $2,579.42
| Professional | | $874.05 | $1,389.38 | $2,579.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $943.90 / $2,567.00
| Professional | | $7.00 | $943.90 | $2,567.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $839.07 / $1,278.93 / $2,081.31
| Professional | | $839.07 | $1,278.93 | $2,081.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $974.01 / $1,001.25 / $1,001.25
| Facility | | $974.01 | $1,001.25 | $1,001.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $953.56 / $1,001.25 / $1,064.45
| Professional | | $953.56 | $1,001.25 | $1,064.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,304.00 / $4,563.00 / $8,261.00
| Facility | | $2,304.00 | $4,563.00 | $8,261.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $903.66 / $1,351.42 / $2,134.32
| Professional | | $903.66 | $1,351.42 | $2,134.32 |