- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,663.12 / $3,111.85 / $8,331.00
| Facility | | $2,663.12 | $3,111.85 | $8,331.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.28 / $1,108.56 / $2,700.61
| Professional | | $924.28 | $1,108.56 | $2,700.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,756.08 / $5,097.00 / $16,742.00
| Facility | | $1,756.08 | $5,097.00 | $16,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,083.33 / $1,873.36 / $7,704.80
| Professional | | $1,083.33 | $1,873.36 | $7,704.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,510.25 / $2,063.88 / $2,795.85
| Professional | | $1,510.25 | $2,063.88 | $2,795.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,090.36 / $1,809.48 / $3,078.19
| Professional | | $1,090.36 | $1,809.48 | $3,078.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,064.90 / $1,909.00 / $7,315.92
| Facility | | $1,064.90 | $1,909.00 | $7,315.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,221.97 / $1,480.21 / $2,019.44
| Professional | | $1,221.97 | $1,480.21 | $2,019.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,330.38 / $2,637.35 / $3,479.08
| Professional | | $1,330.38 | $2,637.35 | $3,479.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,570.59 / $9,840.54 / $9,884.00
| Facility | | $7,570.59 | $9,840.54 | $9,884.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.94 / $258.94 / $258.94
| Professional | | $258.94 | $258.94 | $258.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,992.80 / $26,542.00
| Facility | | $2,324.00 | $5,992.80 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,181.60 / $1,956.53 / $7,704.80
| Professional | | $1,181.60 | $1,956.53 | $7,704.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,097.00 / $10,764.00
| Facility | | $2,324.00 | $5,097.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,149.54 / $1,668.59 / $4,079.96
| Professional | | $1,149.54 | $1,668.59 | $4,079.96 |