- 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
- $1,788.68 / $2,080.37 / $3,268.72
| Professional | | $1,788.68 | $2,080.37 | $3,268.72 |
- 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
- $2,099.90 / $2,179.14 / $2,179.14
| Professional | | $2,099.90 | $2,179.14 | $2,179.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,030.64 / $2,674.41 / $4,400.50
| Professional | | $2,030.64 | $2,674.41 | $4,400.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,626.22 / $3,555.94 / $3,555.94
| Professional | | $2,626.22 | $3,555.94 | $3,555.94 |
- 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
- $1,788.68 / $2,143.37 / $5,272.69
| Professional | | $1,788.68 | $2,143.37 | $5,272.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.00 / $2,405.40 / $5,220.30
| Professional | | $11.00 | $2,405.40 | $5,220.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,030.64 / $2,674.41 / $4,455.01
| Professional | | $2,030.64 | $2,674.41 | $4,455.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,046.74 / $2,046.74 / $2,357.33
| Facility | | $2,046.74 | $2,046.74 | $2,357.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,944.32 / $2,096.27 / $2,357.33
| Professional | | $1,944.32 | $2,096.27 | $2,357.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.00 / $2,391.00 / $6,228.00
| Facility | | $656.00 | $2,391.00 | $6,228.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,111.85 / $2,768.15 / $4,170.20
| Professional | | $2,111.85 | $2,768.15 | $4,170.20 |