- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,919.00 / $6,342.00 / $17,538.00
| Facility | | $1,919.00 | $6,342.00 | $17,538.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,335.17 / $1,490.61 / $1,828.85
| Professional | | $1,335.17 | $1,490.61 | $1,828.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,222.00 / $7,303.00 / $15,399.00
| Facility | | $3,222.00 | $7,303.00 | $15,399.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.34 / $56.55 / $1,487.11
| Professional | | $38.34 | $56.55 | $1,487.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.90 / $100.00 / $5,340.93
| Facility | | $66.90 | $100.00 | $5,340.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,185.52 / $3,764.71 / $8,869.33
| Facility | | $3,185.52 | $3,764.71 | $8,869.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,535.41 / $3,535.41 / $3,712.18
| Professional | | $3,535.41 | $3,535.41 | $3,712.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.93 / $393.93 / $393.93
| Professional | | $393.93 | $393.93 | $393.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,117.37 / $14,302.50 / $14,302.50
| Facility | | $10,117.37 | $14,302.50 | $14,302.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,473.65 / $8,620.34 / $13,322.78
| Professional | | $8,473.65 | $8,620.34 | $13,322.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $841.55 / $1,641.92 / $2,557.59
| Facility | | $841.55 | $1,641.92 | $2,557.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $701.29 / $717.53 / $743.35
| Professional | | $701.29 | $717.53 | $743.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,523.00 / $7,359.00 / $15,471.00
| Facility | | $3,523.00 | $7,359.00 | $15,471.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,316.00 / $1,911.24 / $4,703.14
| Professional | | $1,316.00 | $1,911.24 | $4,703.14 |