- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,397.03 / $5,048.00 / $9,539.00
| Facility | | $2,397.03 | $5,048.00 | $9,539.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,008.51 / $2,397.03 / $2,934.11
| Professional | | $2,008.51 | $2,397.03 | $2,934.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,385.00 / $10,311.04 / $14,433.40
| Facility | | $6,385.00 | $10,311.04 | $14,433.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,911.19 / $2,490.30 / $3,485.12
| Professional | | $1,911.19 | $2,490.30 | $3,485.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,350.16 / $2,353.23 / $4,588.80
| Professional | | $2,350.16 | $2,353.23 | $4,588.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $610.00 / $2,420.59
| Facility | | $490.00 | $610.00 | $2,420.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,663.42 / $2,530.56 / $4,602.02
| Professional | | $1,663.42 | $2,530.56 | $4,602.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,950.76 / $2,409.76 / $3,460.51
| Professional | | $1,950.76 | $2,409.76 | $3,460.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,025.03 / $2,636.73 / $3,936.45
| Facility | | $2,025.03 | $2,636.73 | $3,936.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,411.00 / $2,966.00 / $4,876.97
| Professional | | $2,411.00 | $2,966.00 | $4,876.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,798.47 / $2,533.31 / $4,581.33
| Facility | | $1,798.47 | $2,533.31 | $4,581.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,798.47 / $2,533.31 / $4,581.33
| Professional | | $1,798.47 | $2,533.31 | $4,581.33 |
- 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
- $1,591.53 / $2,330.71 / $3,981.18
| Professional | | $1,591.53 | $2,330.71 | $3,981.18 |