- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,344.18 / $3,316.87 / $5,847.05
| Facility | | $1,344.18 | $3,316.87 | $5,847.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,126.89 / $1,397.98 / $1,807.27
| Professional | | $1,126.89 | $1,397.98 | $1,807.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.28 / $13.28 / $1,632.92
| Professional | | $13.28 | $13.28 | $1,632.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,382.03 / $2,985.18 / $7,425.98
| Facility | | $1,382.03 | $2,985.18 | $7,425.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,875.37 / $3,103.00 / $10,248.28
| Professional | | $1,875.37 | $3,103.00 | $10,248.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $2,551.44 / $4,783.95
| Facility | | $294.00 | $2,551.44 | $4,783.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,232.51 / $2,806.58 / $4,613.85
| Professional | | $2,232.51 | $2,806.58 | $4,613.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,807.27 / $2,126.19 / $3,855.42
| Professional | | $1,807.27 | $2,126.19 | $3,855.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $2,985.18 / $7,654.09
| Facility | | $597.00 | $2,985.18 | $7,654.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,382.03 / $2,317.56 / $4,890.26
| Professional | | $1,382.03 | $2,317.56 | $4,890.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $893.00 / $1,275.72 / $3,222.43
| Professional | | $893.00 | $1,275.72 | $3,222.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.19 / $2,445.08 / $2,445.08
| Facility | | $2,126.19 | $2,445.08 | $2,445.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,807.27 / $2,126.19 / $2,555.52
| Professional | | $1,807.27 | $2,126.19 | $2,555.52 |