- 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
- $1,968.17 / $2,204.17 / $2,878.34
| Professional | | $1,968.17 | $2,204.17 | $2,878.34 |
- 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
- $2,148.23 / $2,229.30 / $2,229.30
| Professional | | $2,148.23 | $2,229.30 | $2,229.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,940.17 / $2,735.96 / $4,392.71
| Professional | | $1,940.17 | $2,735.96 | $4,392.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,550.00 / $3,382.43 / $3,399.73
| Professional | | $2,550.00 | $3,382.43 | $3,399.73 |
- 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
- $1,959.25 / $2,247.39 / $5,782.37
| Professional | | $1,959.25 | $2,247.39 | $5,782.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $2,116.10 / $5,607.00
| Professional | | $6.00 | $2,116.10 | $5,607.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,026.64 / $2,767.61 / $4,543.93
| Professional | | $2,026.64 | $2,767.61 | $4,543.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,117.91 / $2,129.69 / $2,129.69
| Facility | | $2,117.91 | $2,129.69 | $2,129.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,073.23 / $2,129.69 / $2,254.92
| Professional | | $2,073.23 | $2,129.69 | $2,254.92 |
- 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
- $1,832.91 / $2,628.62 / $4,473.50
| Professional | | $1,832.91 | $2,628.62 | $4,473.50 |