- 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
- $1,709.66 / $2,000.72 / $2,709.34
| Professional | | $1,709.66 | $2,000.72 | $2,709.34 |
- 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
- $2,007.59 / $2,083.35 / $2,083.35
| Professional | | $2,007.59 | $2,083.35 | $2,083.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,941.01 / $2,556.83 / $4,204.87
| Professional | | $1,941.01 | $2,556.83 | $4,204.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,510.62 / $3,399.00 / $3,399.00
| Professional | | $2,510.62 | $3,399.00 | $3,399.00 |
- 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
- $1,701.99 / $2,049.01 / $5,958.00
| Professional | | $1,701.99 | $2,049.01 | $5,958.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.00 / $2,168.60 / $4,993.10
| Professional | | $11.00 | $2,168.60 | $4,993.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,941.01 / $2,556.83 / $4,252.39
| Professional | | $1,941.01 | $2,556.83 | $4,252.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,937.63 / $1,955.75 / $1,955.75
| Facility | | $1,937.63 | $1,955.75 | $1,955.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,858.41 / $1,955.75 / $2,075.98
| Professional | | $1,858.41 | $1,955.75 | $2,075.98 |
- 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
- $2,017.10 / $2,708.80 / $3,983.76
| Professional | | $2,017.10 | $2,708.80 | $3,983.76 |