- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,052.28 / $5,048.00 / $9,539.00
| Facility | | $3,052.28 | $5,048.00 | $9,539.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.14 / $3,052.28 / $3,715.91
| Professional | | $2,511.14 | $3,052.28 | $3,715.91 |
- 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
- $2,454.79 / $3,173.48 / $4,486.03
| Professional | | $2,454.79 | $3,173.48 | $4,486.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,986.34 / $2,989.36 / $5,823.36
| Professional | | $2,986.34 | $2,989.36 | $5,823.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $610.00 / $3,070.20
| Facility | | $490.00 | $610.00 | $3,070.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,323.40 / $3,258.17 / $5,829.07
| Professional | | $2,323.40 | $3,258.17 | $5,829.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,483.96 / $3,068.44 / $4,421.51
| Professional | | $2,483.96 | $3,068.44 | $4,421.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,720.52 / $3,468.50 / $5,158.35
| Facility | | $2,720.52 | $3,468.50 | $5,158.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,231.00 / $3,699.00 / $6,197.90
| Professional | | $3,231.00 | $3,699.00 | $6,197.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,542.94 / $3,170.67 / $5,682.92
| Facility | | $2,542.94 | $3,170.67 | $5,682.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,542.94 / $3,170.67 / $5,682.92
| Professional | | $2,542.94 | $3,170.67 | $5,682.92 |
- 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
- $2,082.21 / $3,078.85 / $5,047.60
| Professional | | $2,082.21 | $3,078.85 | $5,047.60 |