- 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
- $2,101.73 / $2,350.10 / $3,350.67
| Professional | | $2,101.73 | $2,350.10 | $3,350.67 |
- 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
- $2,302.58 / $2,389.48 / $2,389.48
| Professional | | $2,302.58 | $2,389.48 | $2,389.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,108.96 / $2,989.52 / $4,790.47
| Professional | | $2,108.96 | $2,989.52 | $4,790.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,763.74 / $3,704.57 / $3,704.57
| Professional | | $2,763.74 | $3,704.57 | $3,704.57 |
- 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
- $2,026.18 / $2,539.96 / $7,346.23
| Professional | | $2,026.18 | $2,539.96 | $7,346.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.00 / $2,019.20 / $5,720.10
| Professional | | $18.00 | $2,019.20 | $5,720.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,172.25 / $3,014.93 / $5,010.96
| Professional | | $2,172.25 | $3,014.93 | $5,010.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,259.66 / $2,259.66 / $2,295.64
| Facility | | $2,259.66 | $2,259.66 | $2,295.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,158.26 / $2,295.64 / $2,365.56
| Professional | | $2,158.26 | $2,295.64 | $2,365.56 |
- 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
- $1,974.66 / $2,874.50 / $5,031.70
| Professional | | $1,974.66 | $2,874.50 | $5,031.70 |