- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,330.14 / $3,021.32 / $5,415.57
| Facility | | $1,330.14 | $3,021.32 | $5,415.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,007.11 / $1,249.38 / $1,615.17
| Professional | | $1,007.11 | $1,249.38 | $1,615.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.00 / $500.00 / $1,332.50
| Professional | | $500.00 | $500.00 | $1,332.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,280.23 / $4,014.17 / $6,841.28
| Facility | | $2,280.23 | $4,014.17 | $6,841.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,314.54 / $9,158.95 / $9,158.95
| Professional | | $2,314.54 | $9,158.95 | $9,158.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $2,470.26 / $4,275.45
| Facility | | $319.00 | $2,470.26 | $4,275.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,330.14 / $2,470.26 / $4,123.43
| Professional | | $1,330.14 | $2,470.26 | $4,123.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,615.17 / $1,900.20 / $3,445.62
| Professional | | $1,615.17 | $1,900.20 | $3,445.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $4,014.17 / $6,841.28
| Facility | | $555.00 | $4,014.17 | $6,841.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,235.13 / $2,052.21 / $4,370.46
| Professional | | $1,235.13 | $2,052.21 | $4,370.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $798.08 / $1,140.11 / $2,945.31
| Professional | | $798.08 | $1,140.11 | $2,945.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,008.26 / $2,185.17 / $2,185.17
| Facility | | $2,008.26 | $2,185.17 | $2,185.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,615.17 / $2,008.26 / $2,291.30
| Professional | | $1,615.17 | $2,008.26 | $2,291.30 |