- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.00 / $2,894.76 / $6,107.00
| Facility | | $2,528.00 | $2,894.76 | $6,107.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $926.63 / $1,324.97 / $3,298.15
| Professional | | $926.63 | $1,324.97 | $3,298.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,939.00 / $6,280.00 / $16,742.00
| Facility | | $1,939.00 | $6,280.00 | $16,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,461.20 / $2,739.94 / $10,116.40
| Professional | | $1,461.20 | $2,739.94 | $10,116.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,697.44 / $2,783.46 / $3,693.12
| Professional | | $1,697.44 | $2,783.46 | $3,693.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,840.04 / $3,068.24 / $5,560.88
| Professional | | $1,840.04 | $3,068.24 | $5,560.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,414.31 / $2,321.33 / $6,679.00
| Facility | | $1,414.31 | $2,321.33 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,622.92 / $2,050.75 / $3,326.73
| Professional | | $1,622.92 | $2,050.75 | $3,326.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.93 / $3,466.13 / $4,619.42
| Professional | | $1,737.93 | $3,466.13 | $4,619.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,989.52 / $3,989.52 / $3,989.52
| Facility | | $3,989.52 | $3,989.52 | $3,989.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,514.72 / $4,514.72 / $4,514.72
| Professional | | $4,514.72 | $4,514.72 | $4,514.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $7,250.00 / $26,542.00
| Facility | | $2,324.00 | $7,250.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,409.46 / $3,074.95 / $10,116.40
| Professional | | $1,409.46 | $3,074.95 | $10,116.40 |
- 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
- $1,405.73 / $2,078.77 / $4,328.49
| Professional | | $1,405.73 | $2,078.77 | $4,328.49 |