- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,125.19 / $5,048.00 / $9,539.00
| Facility | | $2,125.19 | $5,048.00 | $9,539.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,796.46 / $2,125.19 / $2,611.91
| Professional | | $1,796.46 | $2,125.19 | $2,611.91 |
- 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
- $1,715.20 / $2,219.27 / $3,137.16
| Professional | | $1,715.20 | $2,219.27 | $3,137.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,092.84 / $2,096.85 / $4,081.04
| Professional | | $2,092.84 | $2,096.85 | $4,081.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $610.00 / $2,139.92
| Facility | | $490.00 | $610.00 | $2,139.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,617.55 / $2,286.87 / $4,100.25
| Professional | | $1,617.55 | $2,286.87 | $4,100.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,739.20 / $2,148.42 / $3,069.18
| Professional | | $1,739.20 | $2,148.42 | $3,069.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,888.13 / $2,414.79 / $3,591.57
| Facility | | $1,888.13 | $2,414.79 | $3,591.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,176.00 / $2,629.00 / $4,339.06
| Professional | | $2,176.00 | $2,629.00 | $4,339.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,788.73 / $2,276.92 / $4,117.87
| Facility | | $1,788.73 | $2,276.92 | $4,117.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,788.73 / $2,276.92 / $4,117.87
| Professional | | $1,788.73 | $2,276.92 | $4,117.87 |
- 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
- $1,460.76 / $2,145.92 / $3,653.13
| Professional | | $1,460.76 | $2,145.92 | $3,653.13 |