- 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
- $2,023.55 / $2,404.42 / $3,004.23
| Professional | | $2,023.55 | $2,404.42 | $3,004.23 |
- 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
- $2,077.94 / $2,156.35 / $2,156.35
| Professional | | $2,077.94 | $2,156.35 | $2,156.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,046.45 / $2,781.17 / $4,229.75
| Professional | | $2,046.45 | $2,781.17 | $4,229.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,165.16 / $3,165.16 / $3,341.40
| Professional | | $3,165.16 | $3,165.16 | $3,341.40 |
- 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
- $1,827.96 / $2,505.73 / $5,958.00
| Professional | | $1,827.96 | $2,505.73 | $5,958.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.00 / $3,878.20 / $5,158.10
| Professional | | $25.00 | $3,878.20 | $5,158.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,081.17 / $2,784.09 / $4,229.75
| Professional | | $2,081.17 | $2,784.09 | $4,229.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,040.03 / $2,040.03 / $3,295.81
| Facility | | $2,040.03 | $2,040.03 | $3,295.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,947.80 / $2,080.42 / $3,295.81
| Professional | | $1,947.80 | $2,080.42 | $3,295.81 |
- 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
- $1,993.01 / $2,689.45 / $4,192.60
| Professional | | $1,993.01 | $2,689.45 | $4,192.60 |