- 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
- $2,570.16 / $2,885.78 / $3,727.92
| Professional | | $2,570.16 | $2,885.78 | $3,727.92 |
- 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
- $2,563.86 / $4,042.28 / $5,342.69
| Professional | | $2,563.86 | $4,042.28 | $5,342.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,992.11 / $11,617.81 / $13,919.45
| Professional | | $10,992.11 | $11,617.81 | $13,919.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,507.11 / $4,693.21 / $4,693.21
| Professional | | $3,507.11 | $4,693.21 | $4,693.21 |
- 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
- $2,570.16 / $2,914.46 / $7,197.00
| Professional | | $2,570.16 | $2,914.46 | $7,197.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $2,980.60 / $7,297.20
| Professional | | $10.00 | $2,980.60 | $7,297.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,992.11 / $11,617.81 / $13,919.45
| Professional | | $10,992.11 | $11,617.81 | $13,919.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,822.83 / $2,826.40 / $2,826.40
| Facility | | $2,822.83 | $2,826.40 | $2,826.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,716.52 / $2,826.40 / $2,980.04
| Professional | | $2,716.52 | $2,826.40 | $2,980.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.00 / $2,391.00 / $6,322.00
| Facility | | $625.00 | $2,391.00 | $6,322.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,498.48 / $3,527.27 / $5,711.73
| Professional | | $2,498.48 | $3,527.27 | $5,711.73 |