- 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
- $2,522.10 / $3,066.26 / $4,064.26
| Professional | | $2,522.10 | $3,066.26 | $4,064.26 |
- 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
- $3,001.62 / $3,114.89 / $3,114.89
| Professional | | $3,001.62 | $3,114.89 | $3,114.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,672.14 / $3,826.81 / $6,247.07
| Professional | | $2,672.14 | $3,826.81 | $6,247.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,601.07 / $4,827.29 / $4,827.29
| Professional | | $3,601.07 | $4,827.29 | $4,827.29 |
- 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
- $2,522.10 / $3,154.16 / $7,197.00
| Professional | | $2,522.10 | $3,154.16 | $7,197.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.00 / $2,234.90 / $7,452.00
| Professional | | $18.00 | $2,234.90 | $7,452.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,744.57 / $3,826.81 / $6,844.30
| Professional | | $2,744.57 | $3,826.81 | $6,844.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,942.52 / $2,946.73 / $2,946.73
| Facility | | $1,942.52 | $2,946.73 | $2,946.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,942.52 / $2,946.73 / $3,083.26
| Professional | | $1,942.52 | $2,946.73 | $3,083.26 |
- 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
- $2,471.50 / $3,606.32 / $6,577.71
| Professional | | $2,471.50 | $3,606.32 | $6,577.71 |