- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,618.00 / $3,111.85 / $7,625.00
| Facility | | $2,618.00 | $3,111.85 | $7,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.19 / $1,354.20 / $9,341.40
| Professional | | $338.19 | $1,354.20 | $9,341.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.10 / $7,075.00 / $34,324.12
| Facility | | $941.10 | $7,075.00 | $34,324.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.11 / $8,743.37 / $23,049.51
| Professional | | $523.11 | $8,743.37 | $23,049.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $559.78 / $727.71 / $1,427.44
| Facility | | $559.78 | $727.71 | $1,427.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $871.38 / $2,632.51 / $19,824.29
| Professional | | $871.38 | $2,632.51 | $19,824.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $484.02 / $1,020.70 / $6,679.00
| Facility | | $484.02 | $1,020.70 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,379.67 / $7,545.17 / $13,419.30
| Professional | | $6,379.67 | $7,545.17 | $13,419.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $610.71 / $6,210.76 / $15,468.52
| Professional | | $610.71 | $6,210.76 | $15,468.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,138.22 / $19,138.22 / $19,138.22
| Facility | | $19,138.22 | $19,138.22 | $19,138.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,854.00 / $21,140.00
| Facility | | $55.00 | $5,854.00 | $21,140.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,544.68 / $14,431.02 / $36,843.33
| Professional | | $8,544.68 | $14,431.02 | $36,843.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,594.00 / $7,775.00 / $16,522.00
| Facility | | $2,594.00 | $7,775.00 | $16,522.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,118.85 / $11,239.90 / $23,049.51
| Professional | | $8,118.85 | $11,239.90 | $23,049.51 |