- 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
- $1,623.02 / $1,786.06 / $2,184.46
| Professional | | $1,623.02 | $1,786.06 | $2,184.46 |
- 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
- $1,370.00 / $2,158.89 / $3,104.05
| Professional | | $1,370.00 | $2,158.89 | $3,104.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,514.95 / $2,089.33 / $3,225.53
| Professional | | $1,514.95 | $2,089.33 | $3,225.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,339.91 / $2,339.91 / $2,494.21
| Professional | | $2,339.91 | $2,339.91 | $2,494.21 |
- 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
- $1,566.92 / $1,921.77 / $5,553.69
| Professional | | $1,566.92 | $1,921.77 | $5,553.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $2,576.40 / $3,806.40
| Professional | | $15.00 | $2,576.40 | $3,806.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,611.76 / $2,097.71 / $3,255.08
| Professional | | $1,611.76 | $2,097.71 | $3,255.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,521.47 / $1,521.47 / $2,003.03
| Facility | | $1,521.47 | $1,521.47 | $2,003.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,447.53 / $1,551.90 / $2,003.03
| Professional | | $1,447.53 | $1,551.90 | $2,003.03 |
- 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
- $1,555.58 / $2,018.12 / $3,221.09
| Professional | | $1,555.58 | $2,018.12 | $3,221.09 |