- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.53 / $5,412.00 / $13,209.00
| Facility | | $1,965.53 | $5,412.00 | $13,209.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,648.22 / $2,085.71 / $2,518.73
| Professional | | $1,648.22 | $2,085.71 | $2,518.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,142.00 / $37,782.72 / $52,623.67
| Facility | | $7,142.00 | $37,782.72 | $52,623.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,362.44 / $1,742.26 / $2,902.60
| Professional | | $1,362.44 | $1,742.26 | $2,902.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,876.00 / $17,559.00 / $22,492.00
| Professional | | $14,876.00 | $17,559.00 | $22,492.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $640.00 / $2,432.65
| Facility | | $640.00 | $640.00 | $2,432.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,127.93 / $10,127.93 / $10,127.93
| Professional | | $10,127.93 | $10,127.93 | $10,127.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,037.47 / $2,607.14 / $3,015.46
| Professional | | $2,037.47 | $2,607.14 | $3,015.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.53 / $2,474.71 / $3,783.23
| Facility | | $1,965.53 | $2,474.71 | $3,783.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,972.73 / $3,769.76 / $5,031.17
| Professional | | $2,972.73 | $3,769.76 | $5,031.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,528.25 / $2,913.05 / $9,637.00
| Facility | | $1,528.25 | $2,913.05 | $9,637.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,154.15 / $3,033.64 / $9,637.00
| Professional | | $2,154.15 | $3,033.64 | $9,637.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,408.00 / $13,296.00 / $26,537.00
| Facility | | $7,408.00 | $13,296.00 | $26,537.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,053.27 / $1,885.02 / $3,557.98
| Professional | | $1,053.27 | $1,885.02 | $3,557.98 |