- 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
- $3,057.58 / $3,541.09 / $4,692.20
| Professional | | $3,057.58 | $3,541.09 | $4,692.20 |
- 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
- $3,472.87 / $3,603.92 / $3,603.92
| Professional | | $3,472.87 | $3,603.92 | $3,603.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,963.18 / $4,423.00 / $7,219.55
| Professional | | $2,963.18 | $4,423.00 | $7,219.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,169.91 / $5,588.39 / $5,588.39
| Professional | | $4,169.91 | $5,588.39 | $5,588.39 |
- 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
- $3,057.58 / $3,610.53 / $5,970.84
| Professional | | $3,057.58 | $3,610.53 | $5,970.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $2,132.30 / $8,635.40
| Professional | | $15.00 | $2,132.30 | $8,635.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,963.18 / $4,453.46 / $7,534.16
| Professional | | $2,963.18 | $4,453.46 | $7,534.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,316.40 / $3,405.45 / $3,405.45
| Facility | | $3,316.40 | $3,405.45 | $3,405.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,254.48 / $3,405.45 / $3,567.24
| Professional | | $3,254.48 | $3,405.45 | $3,567.24 |
- 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
- $2,904.20 / $4,013.16 / $7,237.56
| Professional | | $2,904.20 | $4,013.16 | $7,237.56 |