- 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
- $2,165.01 / $2,691.17 / $6,064.09
| Professional | | $2,165.01 | $2,691.17 | $6,064.09 |
- 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
- $2,311.48 / $2,398.69 / $2,398.69
| Professional | | $2,311.48 | $2,398.69 | $2,398.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,278.30 / $3,027.02 / $4,676.80
| Professional | | $2,278.30 | $3,027.02 | $4,676.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,528.63 / $3,528.63 / $3,719.02
| Professional | | $3,528.63 | $3,528.63 | $3,719.02 |
- 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
- $2,034.63 / $2,786.83 / $7,197.00
| Professional | | $2,034.63 | $2,786.83 | $7,197.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.00 / $4,174.70 / $5,745.50
| Professional | | $25.00 | $4,174.70 | $5,745.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,324.42 / $3,027.02 / $4,676.80
| Professional | | $2,324.42 | $3,027.02 | $4,676.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,267.31 / $2,267.31 / $2,996.89
| Facility | | $2,267.31 | $2,267.31 | $2,996.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,166.52 / $2,310.69 / $2,996.89
| Professional | | $2,166.52 | $2,310.69 | $2,996.89 |
- 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
- $2,177.61 / $2,938.96 / $4,648.91
| Professional | | $2,177.61 | $2,938.96 | $4,648.91 |