- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,988.53 / $7,452.00 / $10,286.40
| Facility | | $1,988.53 | $7,452.00 | $10,286.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,867.79 / $2,102.16 / $3,809.27
| Professional | | $1,867.79 | $2,102.16 | $3,809.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,393.90 / $3,705.04 / $10,144.44
| Facility | | $2,393.90 | $3,705.04 | $10,144.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,704.45 / $3,240.00 / $12,848.64
| Professional | | $1,704.45 | $3,240.00 | $12,848.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,624.47 / $7,106.67 / $12,874.40
| Facility | | $4,624.47 | $7,106.67 | $12,874.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,045.60 / $3,045.60 / $3,045.60
| Professional | | $3,045.60 | $3,045.60 | $3,045.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,003.49 / $2,527.19 / $7,371.00
| Facility | | $2,003.49 | $2,527.19 | $7,371.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,895.40 / $3,110.36 / $8,445.92
| Professional | | $1,895.40 | $3,110.36 | $8,445.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,675.41 / $4,675.41 / $5,500.48
| Professional | | $4,675.41 | $4,675.41 | $5,500.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,240.00 / $3,240.00 / $10,033.95
| Professional | | $3,240.00 | $3,240.00 | $10,033.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,637.60 / $15,390.00 / $15,390.00
| Facility | | $5,637.60 | $15,390.00 | $15,390.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,704.45 / $1,944.00 / $16,200.00
| Professional | | $1,704.45 | $1,944.00 | $16,200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,704.45 / $1,944.00 / $6,175.67
| Professional | | $1,704.45 | $1,944.00 | $6,175.67 |