- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.00 / $2,894.76 / $6,117.00
| Facility | | $2,528.00 | $2,894.76 | $6,117.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $830.63 / $1,179.71 / $1,970.37
| Professional | | $830.63 | $1,179.71 | $1,970.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,697.00 / $5,381.16 / $13,940.55
| Facility | | $1,697.00 | $5,381.16 | $13,940.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $890.76 / $2,357.92 / $7,293.21
| Professional | | $890.76 | $2,357.92 | $7,293.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,551.78 / $2,451.81 / $3,376.21
| Professional | | $1,551.78 | $2,451.81 | $3,376.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,633.41 / $20,683.62 / $20,683.62
| Facility | | $20,633.41 | $20,683.62 | $20,683.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,534.80 / $2,091.17 / $3,632.62
| Professional | | $1,534.80 | $2,091.17 | $3,632.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,636.10 / $8,090.00
| Facility | | $300.00 | $2,636.10 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.41 / $2,240.69 / $3,093.02
| Professional | | $1,862.41 | $2,240.69 | $3,093.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,634.30 / $3,239.84 / $5,186.97
| Professional | | $1,634.30 | $3,239.84 | $5,186.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,904.00 / $15,421.00
| Facility | | $55.00 | $5,904.00 | $15,421.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $895.22 / $2,108.88 / $9,440.64
| Professional | | $895.22 | $2,108.88 | $9,440.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,904.00 / $13,017.00
| Facility | | $2,386.00 | $5,904.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $864.36 / $2,034.70 / $4,657.10
| Professional | | $864.36 | $2,034.70 | $4,657.10 |