- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,749.00 / $9,697.00 / $21,960.90
| Facility | | $4,749.00 | $9,697.00 | $21,960.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,211.31 / $6,832.95 / $6,832.95
| Professional | | $4,211.31 | $6,832.95 | $6,832.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,446.00 / $9,899.00 / $20,146.00
| Facility | | $4,446.00 | $9,899.00 | $20,146.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,932.25 / $5,867.30 / $13,716.20
| Professional | | $3,932.25 | $5,867.30 | $13,716.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.40 / $100.00 / $5,609.24
| Facility | | $64.40 | $100.00 | $5,609.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Professional | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,051.79 / $5,774.99 / $11,045.83
| Professional | | $4,051.79 | $5,774.99 | $11,045.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.93 / $393.93 / $1,619.00
| Professional | | $393.93 | $393.93 | $1,619.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $32,328.80 / $39,561.68
| Facility | | $55.00 | $32,328.80 | $39,561.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30,534.80 / $31,091.60 / $35,399.03
| Professional | | $30,534.80 | $31,091.60 | $35,399.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,120.66 / $5,971.57 / $7,978.98
| Facility | | $5,120.66 | $5,971.57 | $7,978.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,051.79 / $5,917.67 / $11,045.83
| Professional | | $4,051.79 | $5,917.67 | $11,045.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,009.00 / $5,159.00 / $20,279.00
| Facility | | $2,009.00 | $5,159.00 | $20,279.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,174.37 / $4,648.17 / $12,403.52
| Professional | | $3,174.37 | $4,648.17 | $12,403.52 |