- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.04 / $13,782.00 / $15,333.10
| Facility | | $0.04 | $13,782.00 | $15,333.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,534.32 / $7,748.05 / $8,452.42
| Professional | | $5,534.32 | $7,748.05 | $8,452.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,880.21 / $13,993.95 / $18,382.50
| Facility | | $5,880.21 | $13,993.95 | $18,382.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,018.72 / $5,031.20 / $19,951.88
| Professional | | $3,018.72 | $5,031.20 | $19,951.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,031.20 / $7,194.62 / $12,578.00
| Facility | | $5,031.20 | $7,194.62 | $12,578.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,729.33 / $4,729.33 / $4,729.33
| Professional | | $4,729.33 | $4,729.33 | $4,729.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,236.92 / $3,635.19 / $11,445.98
| Facility | | $3,236.92 | $3,635.19 | $11,445.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,018.74 / $5,307.91 / $22,450.64
| Professional | | $3,018.74 | $5,307.91 | $22,450.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,259.79 / $7,259.79 / $8,540.93
| Professional | | $7,259.79 | $7,259.79 | $8,540.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,031.20 / $5,031.20 / $15,581.12
| Professional | | $5,031.20 | $5,031.20 | $15,581.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,754.29 / $23,898.20 / $23,898.20
| Facility | | $8,754.29 | $23,898.20 | $23,898.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,018.72 / $3,018.72 / $25,156.00
| Professional | | $3,018.72 | $3,018.72 | $25,156.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,018.72 / $5,031.20 / $9,664.94
| Professional | | $3,018.72 | $5,031.20 | $9,664.94 |