- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,546.09 / $9,690.00 / $21,960.90
| Facility | | $3,546.09 | $9,690.00 | $21,960.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,920.96 / $3,312.18 / $3,660.71
| Professional | | $2,920.96 | $3,312.18 | $3,660.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,139.00 / $14,752.00 / $32,242.00
| Facility | | $5,139.00 | $14,752.00 | $32,242.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,711.72 / $6,308.32 / $10,534.31
| Professional | | $4,711.72 | $6,308.32 | $10,534.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.50 / $100.00 / $5,485.17
| Facility | | $63.50 | $100.00 | $5,485.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,562.19 / $3,277.08 / $6,620.93
| Professional | | $2,562.19 | $3,277.08 | $6,620.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.93 / $4,800.00 / $17,033.14
| Professional | | $393.93 | $4,800.00 | $17,033.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $48,434.19 / $66,811.71
| Facility | | $55.00 | $48,434.19 | $66,811.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,716.88 / $19,998.16 / $25,004.85
| Professional | | $18,716.88 | $19,998.16 | $25,004.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $60.00 / $60.00
| Professional | | $60.00 | $60.00 | $60.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,922.49 / $3,550.11 / $5,007.35
| Facility | | $2,922.49 | $3,550.11 | $5,007.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,515.42 / $3,471.17 / $6,813.42
| Professional | | $2,515.42 | $3,471.17 | $6,813.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,047.00 / $5,319.00 / $20,279.00
| Facility | | $2,047.00 | $5,319.00 | $20,279.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,962.09 / $2,832.77 / $7,262.17
| Professional | | $1,962.09 | $2,832.77 | $7,262.17 |