- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,048.00 / $6,272.64 / $11,158.40
| Facility | | $4,048.00 | $6,272.64 | $11,158.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,515.00 / $4,892.80 / $8,887.12
| Professional | | $4,515.00 | $4,892.80 | $8,887.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,118.39 / $4,928.00 / $6,230.40
| Facility | | $4,118.39 | $4,928.00 | $6,230.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,257.23 / $3,608.00 / $10,642.01
| Facility | | $3,257.23 | $3,608.00 | $10,642.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.90 / $4,808.32 / $31,961.60
| Facility | | $59.90 | $4,808.32 | $31,961.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,999.20 / $2,112.00 / $4,170.85
| Professional | | $1,999.20 | $2,112.00 | $4,170.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,004.85 / $1,387.29 / $3,051.83
| Professional | | $1,004.85 | $1,387.29 | $3,051.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,520.00 / $3,520.00 / $3,520.00
| Professional | | $3,520.00 | $3,520.00 | $3,520.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,520.00 / $3,520.00 / $3,520.00
| Professional | | $3,520.00 | $3,520.00 | $3,520.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,601.60 / $2,288.00 / $4,347.20
| Professional | | $1,601.60 | $2,288.00 | $4,347.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,567.17 / $5,805.80 / $9,746.07
| Facility | | $2,567.17 | $5,805.80 | $9,746.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,342.77 / $4,044.92 / $5,056.14
| Professional | | $3,342.77 | $4,044.92 | $5,056.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,224.00 / $4,224.00 / $4,224.00
| Facility | | $4,224.00 | $4,224.00 | $4,224.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,478.40 / $2,112.00 / $4,224.00
| Professional | | $1,478.40 | $2,112.00 | $4,224.00 |