- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,124.73 / $5,282.00 / $29,388.50
| Facility | | $3,124.73 | $5,282.00 | $29,388.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,625.40 / $3,124.73 / $3,842.65
| Professional | | $2,625.40 | $3,124.73 | $3,842.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,362.13 / $8,012.60 / $11,216.04
| Facility | | $5,362.13 | $8,012.60 | $11,216.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,507.46 / $3,206.49 / $4,532.68
| Professional | | $2,507.46 | $3,206.49 | $4,532.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,010.28 / $3,169.96 / $6,181.42
| Professional | | $3,010.28 | $3,169.96 | $6,181.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $610.00 / $3,111.12
| Facility | | $490.00 | $610.00 | $3,111.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,395.85 / $3,461.32 / $5,822.75
| Professional | | $2,395.85 | $3,461.32 | $5,822.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,480.77 / $3,075.38 / $4,731.09
| Professional | | $2,480.77 | $3,075.38 | $4,731.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,795.13 / $3,583.92 / $5,323.96
| Facility | | $2,795.13 | $3,583.92 | $5,323.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,460.00 / $3,901.24 / $6,336.53
| Professional | | $3,460.00 | $3,901.24 | $6,336.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,718.38 / $3,434.87 / $6,025.63
| Facility | | $2,718.38 | $3,434.87 | $6,025.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,718.38 / $3,434.87 / $6,025.63
| Professional | | $2,718.38 | $3,434.87 | $6,025.63 |
- 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
- $2,188.91 / $3,259.70 / $5,197.97
| Professional | | $2,188.91 | $3,259.70 | $5,197.97 |