- 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
- $1,866.69 / $2,093.02 / $2,672.19
| Professional | | $1,866.69 | $2,093.02 | $2,672.19 |
- 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
- $2,097.17 / $2,176.31 / $2,176.31
| Professional | | $2,097.17 | $2,176.31 | $2,176.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,024.29 / $2,710.74 / $4,273.60
| Professional | | $2,024.29 | $2,710.74 | $4,273.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,433.33 / $3,218.70 / $3,223.76
| Professional | | $2,433.33 | $3,218.70 | $3,223.76 |
- 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
- $1,866.69 / $2,218.56 / $5,392.41
| Professional | | $1,866.69 | $2,218.56 | $5,392.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.00 / $2,605.10 / $5,191.00
| Professional | | $8.00 | $2,605.10 | $5,191.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,045.40 / $2,735.83 / $4,282.78
| Professional | | $2,045.40 | $2,735.83 | $4,282.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.51 / $2,041.51 / $2,398.37
| Facility | | $2,041.51 | $2,041.51 | $2,398.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,977.80 / $2,054.05 / $2,398.37
| Professional | | $1,977.80 | $2,054.05 | $2,398.37 |
- 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
- $1,980.02 / $2,597.85 / $4,313.85
| Professional | | $1,980.02 | $2,597.85 | $4,313.85 |