- 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
- $846.78 / $982.93 / $1,341.12
| Professional | | $846.78 | $982.93 | $1,341.12 |
- 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
- $998.31 / $1,035.98 / $1,035.98
| Professional | | $998.31 | $1,035.98 | $1,035.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.17 / $1,271.42 / $2,087.00
| Professional | | $954.17 | $1,271.42 | $2,087.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,248.31 / $1,688.22 / $1,688.22
| Professional | | $1,248.31 | $1,688.22 | $1,688.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $4,761.00 / $8,247.00
| Facility | | $1,013.00 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $848.11 / $1,017.94 / $2,843.00
| Professional | | $848.11 | $1,017.94 | $2,843.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.00 / $1,085.70 / $2,494.60
| Professional | | $9.00 | $1,085.70 | $2,494.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $964.25 / $1,270.69 / $2,095.98
| Professional | | $964.25 | $1,270.69 | $2,095.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $970.70 / $970.70 / $1,261.15
| Facility | | $970.70 | $970.70 | $1,261.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.81 / $991.42 / $1,261.15
| Professional | | $924.81 | $991.42 | $1,261.15 |
- 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
- $993.77 / $1,311.55 / $1,962.06
| Professional | | $993.77 | $1,311.55 | $1,962.06 |