- 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
- $3,046.68 / $3,551.62 / $4,448.46
| Professional | | $3,046.68 | $3,551.62 | $4,448.46 |
- 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
- $3,166.02 / $3,285.49 / $4,867.56
| Professional | | $3,166.02 | $3,285.49 | $4,867.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,117.07 / $4,272.67 / $6,591.24
| Professional | | $3,117.07 | $4,272.67 | $6,591.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,816.51 / $4,816.51 / $5,089.74
| Professional | | $4,816.51 | $4,816.51 | $5,089.74 |
- 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
- $2,783.66 / $3,806.95 / $7,638.70
| Professional | | $2,783.66 | $3,806.95 | $7,638.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.00 / $5,644.30 / $7,854.20
| Professional | | $25.00 | $5,644.30 | $7,854.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,286.67 / $4,272.67 / $6,657.97
| Professional | | $3,286.67 | $4,272.67 | $6,657.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,109.07 / $3,109.07 / $3,399.50
| Facility | | $3,109.07 | $3,109.07 | $3,399.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,967.40 / $3,171.25 / $3,399.50
| Professional | | $2,967.40 | $3,171.25 | $3,399.50 |
- 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
- $3,136.15 / $4,179.14 / $6,635.51
| Professional | | $3,136.15 | $4,179.14 | $6,635.51 |