- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $3,839.00 / $8,247.00
| Facility | | $1,020.00 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,842.93 / $1,972.71 / $2,561.94
| Professional | | $1,842.93 | $1,972.71 | $2,561.94 |
- 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
- $1,906.35 / $3,061.67 / $4,111.39
| Professional | | $1,906.35 | $3,061.67 | $4,111.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,081.83 / $2,813.60 / $4,658.46
| Professional | | $2,081.83 | $2,813.60 | $4,658.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,574.46 / $3,426.68 / $3,426.68
| Professional | | $2,574.46 | $3,426.68 | $3,426.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.00 / $4,761.00 / $8,247.00
| Facility | | $832.00 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,842.93 / $1,982.28 / $3,764.76
| Professional | | $1,842.93 | $1,982.28 | $3,764.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $2,915.10 / $5,482.60
| Professional | | $5.00 | $2,915.10 | $5,482.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,101.71 / $2,857.63 / $4,658.46
| Professional | | $2,101.71 | $2,857.63 | $4,658.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,118.26 / $2,118.26 / $2,455.28
| Facility | | $2,118.26 | $2,118.26 | $2,455.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,049.06 / $2,133.10 / $2,455.28
| Professional | | $2,049.06 | $2,133.10 | $2,455.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $3,914.00 / $7,000.00
| Facility | | $2,332.00 | $3,914.00 | $7,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,915.31 / $2,670.12 / $4,717.67
| Professional | | $1,915.31 | $2,670.12 | $4,717.67 |