- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,466.31 / $5,282.00 / $18,853.66
| Facility | | $2,466.31 | $5,282.00 | $18,853.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,069.13 / $2,466.31 / $3,066.67
| Professional | | $2,069.13 | $2,466.31 | $3,066.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,807.00 / $17,284.09 / $24,194.30
| Facility | | $7,807.00 | $17,284.09 | $24,194.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,000.07 / $2,557.64 / $3,615.47
| Professional | | $2,000.07 | $2,557.64 | $3,615.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,447.90 / $2,598.13 / $5,066.35
| Professional | | $2,447.90 | $2,598.13 | $5,066.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $610.00 / $2,429.19
| Facility | | $490.00 | $610.00 | $2,429.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,830.18 / $2,739.11 / $4,591.56
| Professional | | $1,830.18 | $2,739.11 | $4,591.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,053.79 / $2,493.23 / $3,704.67
| Professional | | $2,053.79 | $2,493.23 | $3,704.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,096.36 / $2,781.12 / $4,189.35
| Facility | | $2,096.36 | $2,781.12 | $4,189.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,773.00 / $3,133.00 / $5,080.22
| Professional | | $2,773.00 | $3,133.00 | $5,080.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,082.27 / $2,704.13 / $4,766.64
| Facility | | $2,082.27 | $2,704.13 | $4,766.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,082.27 / $2,704.13 / $4,766.64
| Professional | | $2,082.27 | $2,704.13 | $4,766.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $327.00 / $2,397.00 / $5,202.00
| Facility | | $327.00 | $2,397.00 | $5,202.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.36 / $2,478.83 / $4,187.22
| Professional | | $1,698.36 | $2,478.83 | $4,187.22 |