- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,301.00 / $4,051.00 / $8,451.00
| Facility | | $1,301.00 | $4,051.00 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,946.27 / $3,354.19 / $4,214.43
| Professional | | $2,946.27 | $3,354.19 | $4,214.43 |
- 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
- $3,003.79 / $3,117.14 / $3,117.14
| Professional | | $3,003.79 | $3,117.14 | $3,117.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,810.50 / $3,884.32 / $6,061.28
| Professional | | $2,810.50 | $3,884.32 | $6,061.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,574.74 / $4,574.74 / $4,801.18
| Professional | | $4,574.74 | $4,574.74 | $4,801.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $5,350.00 / $9,483.95
| Facility | | $1,013.00 | $5,350.00 | $9,483.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,660.24 / $3,626.12 / $7,274.56
| Professional | | $2,660.24 | $3,626.12 | $7,274.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.00 / $4,228.89 / $7,487.10
| Professional | | $20.00 | $4,228.89 | $7,487.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,905.08 / $3,904.00 / $6,061.28
| Professional | | $2,905.08 | $3,904.00 | $6,061.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,950.97 / $2,950.97 / $3,022.91
| Facility | | $2,950.97 | $2,950.97 | $3,022.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,821.70 / $3,005.32 / $3,085.51
| Professional | | $2,821.70 | $3,005.32 | $3,085.51 |
- 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
- $2,693.40 / $3,697.52 / $6,099.46
| Professional | | $2,693.40 | $3,697.52 | $6,099.46 |