- 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
- $2,064.67 / $2,279.12 / $3,655.03
| Professional | | $2,064.67 | $2,279.12 | $3,655.03 |
- 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
- $2,137.89 / $3,277.69 / $4,533.57
| Professional | | $2,137.89 | $3,277.69 | $4,533.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,342.84 / $3,109.12 / $5,077.64
| Professional | | $2,342.84 | $3,109.12 | $5,077.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,031.53 / $4,105.43 / $4,105.43
| Professional | | $3,031.53 | $4,105.43 | $4,105.43 |
- 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
- $2,064.67 / $2,473.73 / $6,085.38
| Professional | | $2,064.67 | $2,473.73 | $6,085.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.00 / $2,797.70 / $6,020.10
| Professional | | $11.00 | $2,797.70 | $6,020.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,342.84 / $3,109.12 / $5,147.92
| Professional | | $2,342.84 | $3,109.12 | $5,147.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,361.69 / $2,361.69 / $2,581.67
| Facility | | $2,361.69 | $2,361.69 | $2,581.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,242.51 / $2,419.61 / $2,581.67
| Professional | | $2,242.51 | $2,419.61 | $2,581.67 |
- 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
- $2,441.26 / $3,149.23 / $4,819.93
| Professional | | $2,441.26 | $3,149.23 | $4,819.93 |