- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,452.34 / $5,412.00 / $11,024.00
| Facility | | $2,452.34 | $5,412.00 | $11,024.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,025.02 / $2,223.96 / $2,872.59
| Professional | | $2,025.02 | $2,223.96 | $2,872.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,685.00 / $17,371.00 / $24,194.30
| Facility | | $8,685.00 | $17,371.00 | $24,194.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,988.39 / $2,542.71 / $4,203.85
| Professional | | $1,988.39 | $2,542.71 | $4,203.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,506.37 / $2,525.07 / $7,889.00
| Professional | | $2,506.37 | $2,525.07 | $7,889.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $640.00 / $2,447.00
| Facility | | $640.00 | $640.00 | $2,447.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,103.90 / $2,898.22 / $4,734.54
| Professional | | $2,103.90 | $2,898.22 | $4,734.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,042.77 / $2,614.75 / $3,038.96
| Professional | | $2,042.77 | $2,614.75 | $3,038.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,223.96 / $2,905.21 / $4,583.88
| Facility | | $2,223.96 | $2,905.21 | $4,583.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,621.00 / $3,107.00 / $4,249.00
| Professional | | $2,621.00 | $3,107.00 | $4,249.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,066.79 / $2,916.07 / $6,585.00
| Facility | | $2,066.79 | $2,916.07 | $6,585.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,066.79 / $2,916.07 / $6,585.00
| Professional | | $2,066.79 | $2,916.07 | $6,585.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,423.00 / $11,475.00 / $21,639.00
| Facility | | $6,423.00 | $11,475.00 | $21,639.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,776.56 / $2,734.30 / $4,271.20
| Professional | | $1,776.56 | $2,734.30 | $4,271.20 |