- 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
- $2,536.11 / $2,854.49 / $3,585.10
| Professional | | $2,536.11 | $2,854.49 | $3,585.10 |
- 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
- $2,557.44 / $2,653.95 / $2,653.95
| Professional | | $2,557.44 | $2,653.95 | $2,653.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,489.98 / $3,294.28 / $5,146.53
| Professional | | $2,489.98 | $3,294.28 | $5,146.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,900.40 / $3,900.40 / $4,089.35
| Professional | | $3,900.40 | $3,900.40 | $4,089.35 |
- 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
- $2,265.52 / $3,083.78 / $6,189.38
| Professional | | $2,265.52 | $3,083.78 | $6,189.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.00 / $4,173.80 / $6,376.90
| Professional | | $18.00 | $4,173.80 | $6,376.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,533.32 / $3,318.43 / $5,146.53
| Professional | | $2,533.32 | $3,318.43 | $5,146.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.29 / $2,511.29 / $3,253.76
| Facility | | $2,511.29 | $2,511.29 | $3,253.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,401.67 / $2,556.60 / $3,253.76
| Professional | | $2,401.67 | $2,556.60 | $3,253.76 |
- 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
- $2,332.88 / $3,208.31 / $5,181.80
| Professional | | $2,332.88 | $3,208.31 | $5,181.80 |