- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,010.41 / $2,747.00 / $5,454.00
| Facility | | $1,010.41 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,010.41 / $1,727.18 / $4,072.99
| Professional | | $1,010.41 | $1,727.18 | $4,072.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $3,390.00 / $7,231.00
| Facility | | $789.00 | $3,390.00 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,475.46 / $2,503.31 / $10,752.72
| Professional | | $1,475.46 | $2,503.31 | $10,752.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,717.68 / $2,816.82 / $3,737.16
| Professional | | $1,717.68 | $2,816.82 | $3,737.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,115.76 / $3,079.47 / $5,473.01
| Professional | | $2,115.76 | $3,079.47 | $5,473.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,328.29 / $8,090.00
| Facility | | $300.00 | $2,328.29 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,730.43 / $2,136.71 / $3,820.31
| Professional | | $1,730.43 | $2,136.71 | $3,820.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,870.64 / $3,548.60 / $4,659.02
| Professional | | $1,870.64 | $3,548.60 | $4,659.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,077.61 / $3,077.61 / $3,167.00
| Professional | | $3,077.61 | $3,077.61 | $3,167.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $22,592.64
| Facility | | $55.00 | $2,854.00 | $22,592.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,849.04 / $3,019.04 / $10,752.72
| Professional | | $1,849.04 | $3,019.04 | $10,752.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,325.00 / $4,662.00
| Facility | | $953.00 | $3,325.00 | $4,662.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,765.92 / $2,403.57 / $5,100.89
| Professional | | $1,765.92 | $2,403.57 | $5,100.89 |