- 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
- $1,744.61 / $2,865.28 / $3,633.06
| Professional | | $1,744.61 | $2,865.28 | $3,633.06 |
- 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
- $2,562.21 / $2,658.91 / $2,658.91
| Professional | | $2,562.21 | $2,658.91 | $2,658.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,891.76 / $3,047.86 / $5,137.01
| Professional | | $1,891.76 | $3,047.86 | $5,137.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,907.23 / $3,907.23 / $4,096.88
| Professional | | $3,907.23 | $3,907.23 | $4,096.88 |
- 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
- $1,615.32 / $3,106.78 / $6,238.84
| Professional | | $1,615.32 | $3,106.78 | $6,238.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.00 / $2,567.19 / $6,427.50
| Professional | | $20.00 | $2,567.19 | $6,427.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,887.33 / $3,047.86 / $5,137.01
| Professional | | $1,887.33 | $3,047.86 | $5,137.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,653.92 / $2,543.08 / $2,543.08
| Facility | | $1,653.92 | $2,543.08 | $2,543.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,653.92 / $2,543.08 / $2,662.15
| Professional | | $1,653.92 | $2,543.08 | $2,662.15 |
- 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
- $1,699.40 / $3,047.69 / $5,387.75
| Professional | | $1,699.40 | $3,047.69 | $5,387.75 |