- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,544.84 / $5,048.00 / $9,539.00
| Facility | | $2,544.84 | $5,048.00 | $9,539.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,099.73 / $2,544.84 / $3,102.33
| Professional | | $2,099.73 | $2,544.84 | $3,102.33 |
- 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
- $2,090.05 / $2,632.31 / $3,728.01
| Professional | | $2,090.05 | $2,632.31 | $3,728.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,485.17 / $2,490.69 / $4,856.85
| Professional | | $2,485.17 | $2,490.69 | $4,856.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $610.00 / $2,540.38
| Facility | | $490.00 | $610.00 | $2,540.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,959.91 / $2,761.13 / $4,936.68
| Professional | | $1,959.91 | $2,761.13 | $4,936.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,060.32 / $2,545.11 / $3,660.76
| Professional | | $2,060.32 | $2,545.11 | $3,660.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,301.52 / $2,905.91 / $4,187.22
| Facility | | $2,301.52 | $2,905.91 | $4,187.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,795.00 / $3,185.59 / $5,144.76
| Professional | | $2,795.00 | $3,185.59 | $5,144.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.17 / $2,723.05 / $4,836.35
| Facility | | $2,218.17 | $2,723.05 | $4,836.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,218.17 / $2,723.05 / $4,836.35
| Professional | | $2,218.17 | $2,723.05 | $4,836.35 |
- 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
- $1,740.31 / $2,598.17 / $4,432.30
| Professional | | $1,740.31 | $2,598.17 | $4,432.30 |