- 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
- $2,032.39 / $2,398.36 / $3,005.49
| Professional | | $2,032.39 | $2,398.36 | $3,005.49 |
- 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
- $2,145.19 / $2,226.14 / $2,226.14
| Professional | | $2,145.19 | $2,226.14 | $2,226.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,900.12 / $2,732.07 / $4,286.38
| Professional | | $1,900.12 | $2,732.07 | $4,286.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,277.71 / $3,277.71 / $3,452.40
| Professional | | $3,277.71 | $3,277.71 | $3,452.40 |
- 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
- $1,888.01 / $2,584.98 / $5,958.00
| Professional | | $1,888.01 | $2,584.98 | $5,958.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.00 / $2,850.90 / $5,332.60
| Professional | | $20.00 | $2,850.90 | $5,332.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,076.76 / $2,771.43 / $4,286.38
| Professional | | $2,076.76 | $2,771.43 | $4,286.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,080.66 / $2,103.29 / $2,103.29
| Facility | | $2,080.66 | $2,103.29 | $2,103.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,008.97 / $2,103.29 / $2,203.32
| Professional | | $2,008.97 | $2,103.29 | $2,203.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.00 / $2,391.00 / $6,322.00
| Facility | | $656.00 | $2,391.00 | $6,322.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,895.35 / $2,787.28 / $4,462.97
| Professional | | $1,895.35 | $2,787.28 | $4,462.97 |