- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,633.00 / $5,673.00 / $13,735.50
| Facility | | $3,633.00 | $5,673.00 | $13,735.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,673.52 / $5,623.34 / $6,825.55
| Professional | | $4,673.52 | $5,623.34 | $6,825.55 |
- 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
- $4,393.93 / $5,727.61 / $8,012.46
| Professional | | $4,393.93 | $5,727.61 | $8,012.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,362.79 / $5,963.51 / $11,628.84
| Professional | | $5,362.79 | $5,963.51 | $11,628.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $610.00 / $5,609.84
| Facility | | $490.00 | $610.00 | $5,609.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,323.48 / $6,044.58 / $10,620.97
| Professional | | $2,323.48 | $6,044.58 | $10,620.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,437.88 / $5,482.09 / $8,528.79
| Professional | | $4,437.88 | $5,482.09 | $8,528.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,244.01 / $6,208.67 / $9,278.51
| Facility | | $3,244.01 | $6,208.67 | $9,278.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,024.00 / $7,132.00 / $11,202.05
| Professional | | $6,024.00 | $7,132.00 | $11,202.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,495.67 / $6,208.89 / $10,727.14
| Facility | | $2,495.67 | $6,208.89 | $10,727.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,495.67 / $6,208.89 / $10,727.14
| Professional | | $2,495.67 | $6,208.89 | $10,727.14 |
- 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
- $2,565.60 / $5,205.52 / $9,839.70
| Professional | | $2,565.60 | $5,205.52 | $9,839.70 |