- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,711.10 / $6,158.07 / $11,038.00
| Facility | | $2,711.10 | $6,158.07 | $11,038.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,110.79 / $3,137.13 / $3,873.00
| Professional | | $2,110.79 | $3,137.13 | $3,873.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,873.00 / $3,873.00 / $10,069.79
| Facility | | $3,873.00 | $3,873.00 | $10,069.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $573.20 / $573.20 / $5,584.87
| Professional | | $573.20 | $573.20 | $5,584.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,873.00 / $3,873.00 / $3,873.00
| Facility | | $3,873.00 | $3,873.00 | $3,873.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,827.29 / $3,873.00 / $3,873.00
| Professional | | $2,827.29 | $3,873.00 | $3,873.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,647.60 / $7,843.50 / $10,050.62
| Facility | | $4,647.60 | $7,843.50 | $10,050.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,265.71 / $5,652.12 / $18,667.86
| Professional | | $2,265.71 | $5,652.12 | $18,667.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $4,647.60 / $8,714.25
| Facility | | $294.00 | $4,647.60 | $8,714.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,066.65 / $5,112.35 / $8,404.41
| Professional | | $4,066.65 | $5,112.35 | $8,404.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,292.05 / $3,825.11 / $7,022.89
| Professional | | $3,292.05 | $3,825.11 | $7,022.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,776.18 / $9,450.00 / $10,050.62
| Facility | | $3,776.18 | $9,450.00 | $10,050.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,517.44 / $4,221.57 / $8,907.90
| Professional | | $2,517.44 | $4,221.57 | $8,907.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,626.66 / $2,323.80 / $5,869.84
| Professional | | $1,626.66 | $2,323.80 | $5,869.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,873.00 / $4,453.85 / $4,453.85
| Facility | | $3,873.00 | $4,453.85 | $4,453.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,292.05 / $3,873.00 / $4,655.02
| Professional | | $3,292.05 | $3,873.00 | $4,655.02 |