- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,209.71 / $5,048.00 / $9,541.12
| Facility | | $3,209.71 | $5,048.00 | $9,541.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,661.98 / $3,209.71 / $3,920.91
| Professional | | $2,661.98 | $3,209.71 | $3,920.91 |
- 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
- $2,537.14 / $3,305.91 / $4,628.88
| Professional | | $2,537.14 | $3,305.91 | $4,628.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,107.19 / $3,210.40 / $6,260.28
| Professional | | $3,107.19 | $3,210.40 | $6,260.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $610.00 / $3,227.34
| Facility | | $490.00 | $610.00 | $3,227.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,055.10 / $3,417.91 / $6,109.10
| Professional | | $2,055.10 | $3,417.91 | $6,109.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,573.44 / $3,178.96 / $4,808.88
| Professional | | $2,573.44 | $3,178.96 | $4,808.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,629.56 / $3,611.63 / $5,424.41
| Facility | | $2,629.56 | $3,611.63 | $5,424.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,292.00 / $4,009.00 / $6,474.94
| Professional | | $3,292.00 | $4,009.00 | $6,474.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,195.39 / $3,431.71 / $6,150.06
| Facility | | $2,195.39 | $3,431.71 | $6,150.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,195.39 / $3,431.71 / $6,150.06
| Professional | | $2,195.39 | $3,431.71 | $6,150.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $2,945.00 / $5,445.00
| Facility | | $425.00 | $2,945.00 | $5,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,059.03 / $3,063.49 / $5,634.19
| Professional | | $2,059.03 | $3,063.49 | $5,634.19 |