- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,488.34 / $3,380.66 / $6,059.67
| Facility | | $1,488.34 | $3,380.66 | $6,059.67 |
- 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
- $21.15 / $21.15 / $1,275.72
| Professional | | $21.15 | $21.15 | $1,275.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,551.44 / $4,491.60 / $7,654.09
| Facility | | $2,551.44 | $4,491.60 | $7,654.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,589.91 / $10,248.28 / $10,248.28
| Professional | | $2,589.91 | $10,248.28 | $10,248.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.00 / $2,126.19 / $4,783.95
| Facility | | $332.00 | $2,126.19 | $4,783.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,488.34 / $2,764.06 / $4,613.85
| Professional | | $1,488.34 | $2,764.06 | $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 / $4,491.60 / $7,654.09
| Facility | | $597.00 | $4,491.60 | $7,654.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,382.03 / $2,296.30 / $4,890.26
| Professional | | $1,382.03 | $2,296.30 | $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
- $2,171.31 / $2,445.08 / $2,445.08
| Facility | | $2,171.31 | $2,445.08 | $2,445.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,807.27 / $2,171.31 / $2,555.52
| Professional | | $1,807.27 | $2,171.31 | $2,555.52 |