- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,179.75 / $5,234.43 / $9,586.02
| Facility | | $3,179.75 | $5,234.43 | $9,586.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,442.73 / $2,791.70 / $2,966.19
| Professional | | $2,442.73 | $2,791.70 | $2,966.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.60 / $2,523.00 / $9,840.76
| Facility | | $92.60 | $2,523.00 | $9,840.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,082.86 / $4,885.47 / $6,176.64
| Facility | | $4,082.86 | $4,885.47 | $6,176.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $420.00 / $5,121.03 / $13,609.56
| Facility | | $420.00 | $5,121.03 | $13,609.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.00 / $222.00 / $2,491.59
| Professional | | $200.00 | $222.00 | $2,491.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,587.78 / $2,268.26 / $5,671.78
| Professional | | $1,587.78 | $2,268.26 | $5,671.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,093.78 / $2,093.78 / $2,966.19
| Professional | | $2,093.78 | $2,093.78 | $2,966.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,494.20 / $5,412.79 / $10,710.66
| Facility | | $2,494.20 | $5,412.79 | $10,710.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,859.33 / $4,187.56 / $4,623.91
| Professional | | $3,859.33 | $4,187.56 | $4,623.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,465.64 / $2,093.78 / $3,946.77
| Professional | | $1,465.64 | $2,093.78 | $3,946.77 |