- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,934.32 / $4,796.00 / $9,539.00
| Facility | | $1,934.32 | $4,796.00 | $9,539.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.16 / $1,934.32 / $2,406.71
| Professional | | $1,659.16 | $1,934.32 | $2,406.71 |
- 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
- $1,614.11 / $2,045.17 / $2,891.05
| Professional | | $1,614.11 | $2,045.17 | $2,891.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,927.12 / $1,929.84 / $3,757.88
| Professional | | $1,927.12 | $1,929.84 | $3,757.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $610.00 / $1,974.88
| Facility | | $490.00 | $610.00 | $1,974.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,544.69 / $2,162.34 / $3,777.48
| Professional | | $1,544.69 | $2,162.34 | $3,777.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,599.96 / $1,976.43 / $2,879.06
| Professional | | $1,599.96 | $1,976.43 | $2,879.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,786.98 / $2,246.26 / $3,338.73
| Facility | | $1,786.98 | $2,246.26 | $3,338.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,138.00 / $2,426.23 / $3,996.53
| Professional | | $2,138.00 | $2,426.23 | $3,996.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,709.54 / $2,119.82 / $3,850.35
| Facility | | $1,709.54 | $2,119.82 | $3,850.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,709.54 / $2,119.82 / $3,850.35
| Professional | | $1,709.54 | $2,119.82 | $3,850.35 |
- 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
- $1,345.98 / $2,025.62 / $3,418.56
| Professional | | $1,345.98 | $2,025.62 | $3,418.56 |