- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $8,709.64 / $12,022.64
| Facility | | $2,691.53 | $8,709.64 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,090.30 / $3,715.35
| Professional | | $2,570.40 | $3,090.30 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $10,000.00 / $18,197.01
| Facility | | $4,073.80 | $10,000.00 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,890.45 / $11,481.54
| Professional | | $2,344.23 | $3,890.45 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $4,786.30 / $6,918.31
| Facility | | $3,890.45 | $4,786.30 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,019.95 / $6,165.95
| Facility | | $2,754.23 | $3,019.95 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,677.35 / $5,623.41
| Professional | | $2,290.87 | $4,677.35 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $6,606.93
| Professional | | $5,623.41 | $5,623.41 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $3,890.45 / $8,317.64
| Professional | | $3,890.45 | $3,890.45 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $10,000.00 / $18,197.01
| Facility | | $4,073.80 | $10,000.00 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,890.45 / $11,481.54
| Professional | | $2,344.23 | $3,890.45 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,890.45 / $4,677.35
| Facility | | $2,344.23 | $3,890.45 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,388.44 / $7,943.28
| Professional | | $2,344.23 | $3,388.44 | $7,943.28 |