- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,091.61 / $5,048.00 / $9,539.00
| Facility | | $3,091.61 | $5,048.00 | $9,539.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,564.04 / $3,091.61 / $3,752.24
| Professional | | $2,564.04 | $3,091.61 | $3,752.24 |
- 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
- $2,671.28 / $3,415.96 / $4,828.80
| Professional | | $2,671.28 | $3,415.96 | $4,828.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,221.15 / $3,247.48 / $6,332.59
| Professional | | $3,221.15 | $3,247.48 | $6,332.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $610.00 / $3,301.00
| Facility | | $490.00 | $610.00 | $3,301.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,551.28 / $3,522.92 / $6,186.55
| Professional | | $2,551.28 | $3,522.92 | $6,186.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,677.41 / $3,307.38 / $4,724.84
| Professional | | $2,677.41 | $3,307.38 | $4,724.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,863.20 / $3,570.58 / $5,224.82
| Facility | | $2,863.20 | $3,570.58 | $5,224.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,415.00 / $3,957.76 / $6,673.73
| Professional | | $3,415.00 | $3,957.76 | $6,673.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,770.88 / $3,484.45 / $5,977.10
| Facility | | $2,770.88 | $3,484.45 | $5,977.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,770.88 / $3,484.45 / $5,977.10
| Professional | | $2,770.88 | $3,484.45 | $5,977.10 |
- 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
- $2,196.14 / $3,303.60 / $5,216.35
| Professional | | $2,196.14 | $3,303.60 | $5,216.35 |