- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $4,125.81 / $8,247.00
| Facility | | $1,020.00 | $4,125.81 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,291.46 / $3,968.29 / $4,807.95
| Professional | | $3,291.46 | $3,968.29 | $4,807.95 |
- 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
- $3,421.29 / $3,550.39 / $5,260.29
| Professional | | $3,421.29 | $3,550.39 | $5,260.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,366.71 / $4,619.07 / $7,123.04
| Professional | | $3,366.71 | $4,619.07 | $7,123.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,202.93 / $5,202.93 / $5,500.63
| Professional | | $5,202.93 | $5,202.93 | $5,500.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $4,761.00 / $8,247.00
| Facility | | $1,013.00 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,007.44 / $3,968.29 / $7,271.96
| Professional | | $3,007.44 | $3,968.29 | $7,271.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.00 / $6,096.30 / $8,482.50
| Professional | | $25.00 | $6,096.30 | $8,482.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,553.13 / $4,619.07 / $7,196.59
| Professional | | $3,553.13 | $4,619.07 | $7,196.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,359.92 / $3,359.92 / $3,668.60
| Facility | | $3,359.92 | $3,359.92 | $3,668.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,206.45 / $3,427.12 / $3,668.60
| Professional | | $3,206.45 | $3,427.12 | $3,668.60 |
- 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
- $3,389.01 / $4,481.64 / $7,730.16
| Professional | | $3,389.01 | $4,481.64 | $7,730.16 |