- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,301.00 / $3,964.00 / $8,451.00
| Facility | | $1,301.00 | $3,964.00 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,971.01 / $2,265.62 / $2,842.86
| Professional | | $1,971.01 | $2,265.62 | $2,842.86 |
- 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
- $2,021.60 / $2,097.89 / $2,097.89
| Professional | | $2,021.60 | $2,097.89 | $2,097.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,959.87 / $2,611.56 / $4,069.11
| Professional | | $1,959.87 | $2,611.56 | $4,069.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,074.99 / $3,074.99 / $3,250.29
| Professional | | $3,074.99 | $3,074.99 | $3,250.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $5,342.00 / $8,990.00
| Facility | | $1,013.00 | $5,342.00 | $8,990.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.51 / $2,439.81 / $5,958.00
| Professional | | $1,778.51 | $2,439.81 | $5,958.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.00 / $3,165.80 / $5,017.70
| Professional | | $20.00 | $3,165.80 | $5,017.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,001.07 / $2,618.94 / $4,069.11
| Professional | | $2,001.07 | $2,618.94 | $4,069.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,986.79 / $1,986.79 / $2,767.35
| Facility | | $1,986.79 | $1,986.79 | $2,767.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,896.16 / $2,026.53 / $2,767.35
| Professional | | $1,896.16 | $2,026.53 | $2,767.35 |
- 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
- $1,904.57 / $2,540.15 / $4,083.46
| Professional | | $1,904.57 | $2,540.15 | $4,083.46 |