- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,633.00 / $5,282.00 / $11,626.60
| Facility | | $3,633.00 | $5,282.00 | $11,626.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,989.67 / $4,835.41 / $5,871.76
| Professional | | $3,989.67 | $4,835.41 | $5,871.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,032.00 / $6,548.00 / $7,221.00
| Facility | | $5,032.00 | $6,548.00 | $7,221.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,924.65 / $5,024.10 / $7,102.08
| Professional | | $3,924.65 | $5,024.10 | $7,102.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,341.49 / $4,341.49 / $8,465.91
| Professional | | $4,341.49 | $4,341.49 | $8,465.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $610.00 / $4,856.28
| Facility | | $490.00 | $610.00 | $4,856.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,671.99 / $5,180.18 / $9,490.40
| Professional | | $3,671.99 | $5,180.18 | $9,490.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,937.92 / $4,864.49 / $6,949.28
| Professional | | $3,937.92 | $4,864.49 | $6,949.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,246.72 / $5,464.01 / $7,923.44
| Facility | | $4,246.72 | $5,464.01 | $7,923.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,066.51 / $5,860.00 / $9,815.18
| Professional | | $5,066.51 | $5,860.00 | $9,815.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,022.82 / $5,006.32 / $9,001.52
| Facility | | $4,022.82 | $5,006.32 | $9,001.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,022.82 / $5,006.32 / $9,001.52
| Professional | | $4,022.82 | $5,006.32 | $9,001.52 |
- 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
- $3,243.43 / $4,863.45 / $8,181.94
| Professional | | $3,243.43 | $4,863.45 | $8,181.94 |