- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,124.20 / $5,282.00 / $10,767.00
| Facility | | $3,124.20 | $5,282.00 | $10,767.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,614.67 / $3,124.20 / $3,872.86
| Professional | | $2,614.67 | $3,124.20 | $3,872.86 |
- 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
- $2,507.17 / $3,220.24 / $4,552.13
| Professional | | $2,507.17 | $3,220.24 | $4,552.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,076.40 / $3,267.35 / $6,371.33
| Professional | | $3,076.40 | $3,267.35 | $6,371.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $610.00 / $3,064.82
| Facility | | $490.00 | $610.00 | $3,064.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,252.40 / $3,396.04 / $5,791.81
| Professional | | $2,252.40 | $3,396.04 | $5,791.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,585.10 / $3,133.28 / $4,650.93
| Professional | | $2,585.10 | $3,133.28 | $4,650.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,655.57 / $3,494.46 / $5,279.90
| Facility | | $2,655.57 | $3,494.46 | $5,279.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,307.00 / $3,953.00 / $6,394.63
| Professional | | $3,307.00 | $3,953.00 | $6,394.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,585.11 / $3,381.13 / $6,000.57
| Facility | | $2,585.11 | $3,381.13 | $6,000.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,585.11 / $3,381.13 / $6,000.57
| Professional | | $2,585.11 | $3,381.13 | $6,000.57 |
- 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
- $2,136.67 / $3,141.83 / $5,152.10
| Professional | | $2,136.67 | $3,141.83 | $5,152.10 |