- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,110.48 / $5,411.00 / $10,965.00
| Facility | | $2,110.48 | $5,411.00 | $10,965.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,264.68 / $2,110.48 / $2,260.14
| Professional | | $1,264.68 | $2,110.48 | $2,260.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,568.00 / $7,578.00 / $14,193.00
| Facility | | $4,568.00 | $7,578.00 | $14,193.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,799.73 / $4,547.55 / $8,601.31
| Professional | | $3,799.73 | $4,547.55 | $8,601.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,123.45 / $4,123.45 / $7,227.90
| Facility | | $4,123.45 | $4,123.45 | $7,227.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,175.33 / $14,175.33 / $14,175.33
| Professional | | $14,175.33 | $14,175.33 | $14,175.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,095.99 / $5,095.99 / $5,095.99
| Professional | | $5,095.99 | $5,095.99 | $5,095.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,687.72 / $3,600.38 / $4,165.39
| Professional | | $1,687.72 | $3,600.38 | $4,165.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $4,123.45 / $7,227.90
| Facility | | $555.00 | $4,123.45 | $7,227.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,175.33 / $14,175.33 / $14,175.33
| Professional | | $14,175.33 | $14,175.33 | $14,175.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,444.00 / $6,762.00 / $16,403.00
| Facility | | $2,444.00 | $6,762.00 | $16,403.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,906.52 / $3,119.09 / $6,558.02
| Professional | | $1,906.52 | $3,119.09 | $6,558.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,124.54 / $2,124.54 / $2,124.54
| Facility | | $2,124.54 | $2,124.54 | $2,124.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,687.72 / $2,796.19 / $4,165.39
| Professional | | $1,687.72 | $2,796.19 | $4,165.39 |