- 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
- $2,270.04 / $2,480.30 / $3,234.75
| Professional | | $2,270.04 | $2,480.30 | $3,234.75 |
- 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
- $2,209.29 / $3,499.75 / $4,557.91
| Professional | | $2,209.29 | $3,499.75 | $4,557.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,372.30 / $3,221.06 / $5,125.27
| Professional | | $2,372.30 | $3,221.06 | $5,125.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,971.93 / $3,942.18 / $3,960.31
| Professional | | $2,971.93 | $3,942.18 | $3,960.31 |
- 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
- $2,270.04 / $2,597.94 / $6,744.48
| Professional | | $2,270.04 | $2,597.94 | $6,744.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $2,681.50 / $6,538.80
| Professional | | $5.00 | $2,681.50 | $6,538.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,432.54 / $3,250.82 / $5,434.23
| Professional | | $2,432.54 | $3,250.82 | $5,434.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,484.92 / $2,484.92 / $2,658.56
| Facility | | $2,484.92 | $2,484.92 | $2,658.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,418.58 / $2,487.19 / $2,658.56
| Professional | | $2,418.58 | $2,487.19 | $2,658.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.00 / $2,391.00 / $6,228.00
| Facility | | $625.00 | $2,391.00 | $6,228.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,130.73 / $2,882.75 / $4,849.97
| Professional | | $2,130.73 | $2,882.75 | $4,849.97 |