- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,734.59 / $6,232.80 / $11,172.00
| Facility | | $2,734.59 | $6,232.80 | $11,172.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,077.60 / $2,577.40 / $3,332.00
| Professional | | $2,077.60 | $2,577.40 | $3,332.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,920.00 / $3,920.00 / $10,192.00
| Facility | | $3,920.00 | $3,920.00 | $10,192.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.33 / $335.33 / $7,554.31
| Professional | | $335.33 | $335.33 | $7,554.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,508.00 / $7,583.88 / $14,112.26
| Facility | | $4,508.00 | $7,583.88 | $14,112.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,774.87 / $18,894.40 / $18,894.40
| Professional | | $4,774.87 | $18,894.40 | $18,894.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $5,096.00 / $8,820.00
| Facility | | $319.00 | $5,096.00 | $8,820.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,744.00 / $5,096.00 / $8,506.40
| Professional | | $2,744.00 | $5,096.00 | $8,506.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,051.50 / $3,724.00 / $6,509.72
| Professional | | $3,051.50 | $3,724.00 | $6,509.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $7,583.88 / $14,112.26
| Facility | | $597.00 | $7,583.88 | $14,112.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,548.00 / $4,233.60 / $9,016.00
| Professional | | $2,548.00 | $4,233.60 | $9,016.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,646.40 / $2,352.00 / $6,153.81
| Professional | | $1,646.40 | $2,352.00 | $6,153.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,003.17 / $4,128.41 / $4,128.41
| Facility | | $4,003.17 | $4,128.41 | $4,128.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,051.50 / $3,949.01 / $4,567.38
| Professional | | $3,051.50 | $3,949.01 | $4,567.38 |