- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,269.43 / $5,048.00 / $9,619.51
| Facility | | $3,269.43 | $5,048.00 | $9,619.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,753.61 / $3,269.43 / $3,997.98
| Professional | | $2,753.61 | $3,269.43 | $3,997.98 |
- 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
- $2,651.30 / $3,390.41 / $4,792.68
| Professional | | $2,651.30 | $3,390.41 | $4,792.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,194.42 / $3,203.04 / $6,245.93
| Professional | | $3,194.42 | $3,203.04 | $6,245.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $610.00 / $3,279.28
| Facility | | $490.00 | $610.00 | $3,279.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,491.17 / $3,538.12 / $6,272.68
| Professional | | $2,491.17 | $3,538.12 | $6,272.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,647.46 / $3,270.39 / $4,720.10
| Professional | | $2,647.46 | $3,270.39 | $4,720.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,888.43 / $3,705.14 / $5,525.34
| Facility | | $2,888.43 | $3,705.14 | $5,525.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,522.00 / $4,046.00 / $6,622.01
| Professional | | $3,522.00 | $4,046.00 | $6,622.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,823.35 / $3,488.09 / $6,182.20
| Facility | | $2,823.35 | $3,488.09 | $6,182.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,823.35 / $3,488.09 / $6,182.20
| Professional | | $2,823.35 | $3,488.09 | $6,182.20 |
- 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
- $2,248.81 / $3,396.40 / $5,412.13
| Professional | | $2,248.81 | $3,396.40 | $5,412.13 |