- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,633.00 / $5,048.00 / $11,950.60
| Facility | | $3,633.00 | $5,048.00 | $11,950.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,090.26 / $4,926.33 / $5,962.33
| Professional | | $4,090.26 | $4,926.33 | $5,962.33 |
- 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
- $3,847.05 / $5,014.74 / $7,015.21
| Professional | | $3,847.05 | $5,014.74 | $7,015.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,701.68 / $5,080.95 / $9,907.85
| Professional | | $4,701.68 | $5,080.95 | $9,907.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $610.00 / $4,904.50
| Facility | | $490.00 | $610.00 | $4,904.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,463.34 / $5,210.77 / $9,382.42
| Professional | | $2,463.34 | $5,210.77 | $9,382.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,893.12 / $4,809.14 / $7,498.72
| Professional | | $3,893.12 | $4,809.14 | $7,498.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.19 / $5,491.33 / $8,072.99
| Facility | | $3,467.19 | $5,491.33 | $8,072.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,169.00 / $6,084.00 / $9,812.04
| Professional | | $5,169.00 | $6,084.00 | $9,812.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,592.29 / $5,310.46 / $9,491.35
| Facility | | $2,592.29 | $5,310.46 | $9,491.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,592.29 / $5,310.46 / $9,491.35
| Professional | | $2,592.29 | $5,310.46 | $9,491.35 |
- 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
- $2,725.93 / $4,496.00 / $8,103.94
| Professional | | $2,725.93 | $4,496.00 | $8,103.94 |