- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,188.44 / $4,886.68 / $6,372.99
| Facility | | $2,188.44 | $4,886.68 | $6,372.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,930.99 / $2,188.44 / $2,188.44
| Professional | | $1,930.99 | $2,188.44 | $2,188.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,778.52 / $12,538.55 / $15,834.10
| Facility | | $9,778.52 | $12,538.55 | $15,834.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,800.00 / $4,800.00 / $6,900.48
| Professional | | $4,800.00 | $4,800.00 | $6,900.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,059.71 / $2,368.67 / $4,618.93
| Professional | | $2,059.71 | $2,368.67 | $4,618.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,673.52 / $5,675.35 / $13,189.75
| Facility | | $1,673.52 | $5,675.35 | $13,189.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,135.82 / $3,135.82 / $3,757.07
| Professional | | $3,135.82 | $3,135.82 | $3,757.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,574.65 / $3,089.58 / $3,810.48
| Professional | | $2,574.65 | $3,089.58 | $3,810.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,046.85 / $2,574.65 / $4,376.89
| Facility | | $2,046.85 | $2,574.65 | $4,376.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,527.00 / $4,505.64 / $6,179.16
| Professional | | $3,527.00 | $4,505.64 | $6,179.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,802.26 / $2,857.35 / $4,780.10
| Facility | | $1,802.26 | $2,857.35 | $4,780.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,802.26 / $2,927.38 / $4,780.10
| Professional | | $1,802.26 | $2,927.38 | $4,780.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,081.34 / $1,287.33 / $2,960.85
| Professional | | $1,081.34 | $1,287.33 | $2,960.85 |