- 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
- $1,729.68 / $1,908.62 / $2,744.13
| Professional | | $1,729.68 | $1,908.62 | $2,744.13 |
- 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
- $1,792.04 / $2,652.46 / $3,634.06
| Professional | | $1,792.04 | $2,652.46 | $3,634.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,936.19 / $2,594.34 / $4,255.25
| Professional | | $1,936.19 | $2,594.34 | $4,255.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,541.02 / $3,441.45 / $3,441.45
| Professional | | $2,541.02 | $3,441.45 | $3,441.45 |
- 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
- $1,717.97 / $2,094.17 / $5,096.75
| Professional | | $1,717.97 | $2,094.17 | $5,096.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.00 / $2,219.19 / $5,039.89
| Professional | | $11.00 | $2,219.19 | $5,039.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,936.19 / $2,594.34 / $4,531.46
| Professional | | $1,936.19 | $2,594.34 | $4,531.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,979.19 / $1,979.19 / $2,126.17
| Facility | | $1,979.19 | $1,979.19 | $2,126.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,879.11 / $2,028.14 / $2,126.17
| Professional | | $1,879.11 | $2,028.14 | $2,126.17 |
- 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
- $1,906.45 / $2,562.98 / $4,047.85
| Professional | | $1,906.45 | $2,562.98 | $4,047.85 |