- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,230.13 / $3,166.24 / $7,172.21
| Facility | | $2,230.13 | $3,166.24 | $7,172.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.43 / $2,120.00 / $2,312.73
| Professional | | $455.43 | $2,120.00 | $2,312.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,221.30 / $3,854.55 / $4,873.25
| Facility | | $3,221.30 | $3,854.55 | $4,873.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.04 / $4,291.35 / $12,011.60
| Facility | | $620.04 | $4,291.35 | $12,011.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,651.95 / $1,651.95 / $2,340.26
| Professional | | $1,651.95 | $1,651.95 | $2,340.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.00 / $222.56 / $2,753.25
| Professional | | $208.00 | $222.56 | $2,753.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,340.26 / $2,753.25 / $2,753.25
| Professional | | $2,340.26 | $2,753.25 | $2,753.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,753.25 / $2,753.25 / $4,184.93
| Professional | | $2,753.25 | $2,753.25 | $4,184.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,252.73 / $1,789.61 / $4,474.92
| Professional | | $1,252.73 | $1,789.61 | $4,474.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,457.13 / $4,652.99 / $8,259.04
| Facility | | $2,457.13 | $4,652.99 | $8,259.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,303.90 / $3,353.83 / $4,018.27
| Professional | | $3,303.90 | $3,353.83 | $4,018.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,514.29 / $1,514.29 / $2,753.00
| Facility | | $1,514.29 | $1,514.29 | $2,753.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,156.36 / $1,651.95 / $3,166.24
| Professional | | $1,156.36 | $1,651.95 | $3,166.24 |