- 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
- $2,178.69 / $2,426.80 / $3,028.64
| Professional | | $2,178.69 | $2,426.80 | $3,028.64 |
- 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
- $1,897.49 / $2,844.82 / $4,125.41
| Professional | | $1,897.49 | $2,844.82 | $4,125.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,097.46 / $2,816.95 / $4,354.45
| Professional | | $2,097.46 | $2,816.95 | $4,354.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.95 / $3,235.95 / $3,453.08
| Professional | | $3,235.95 | $3,235.95 | $3,453.08 |
- 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
- $1,871.59 / $2,447.71 / $5,181.72
| Professional | | $1,871.59 | $2,447.71 | $5,181.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $3,929.40 / $5,268.00
| Professional | | $15.00 | $3,929.40 | $5,268.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,232.34 / $2,817.93 / $4,354.45
| Professional | | $2,232.34 | $2,817.93 | $4,354.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,108.46 / $2,108.46 / $2,113.75
| Facility | | $2,108.46 | $2,108.46 | $2,113.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,004.26 / $2,113.75 / $2,195.69
| Professional | | $2,004.26 | $2,113.75 | $2,195.69 |
- 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
- $2,130.87 / $2,868.51 / $4,525.72
| Professional | | $2,130.87 | $2,868.51 | $4,525.72 |