- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,388.44 / $5,623.41
| Facility | | $2,691.53 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,888.44 / $13,803.84
| Professional | | $3,235.94 | $5,888.44 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,548.13 / $15,488.17
| Facility | | $56.23 | $3,548.13 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $6,606.93 / $38,018.94
| Professional | | $3,715.35 | $6,606.93 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $5,888.44 / $9,549.93
| Facility | | $302.00 | $5,888.44 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,370.32 / $6,456.54 / $8,709.64
| Professional | | $5,370.32 | $6,456.54 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,311.31 / $5,888.44
| Facility | | $1,000.00 | $3,311.31 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $6,606.93 / $12,589.25
| Professional | | $4,677.35 | $6,606.93 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,548.13 / $15,488.17
| Facility | | $56.23 | $3,548.13 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $6,606.93 / $38,018.94
| Professional | | $3,715.35 | $6,606.93 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,311.31 / $4,677.35
| Facility | | $1,000.00 | $3,311.31 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $6,918.31 / $14,454.40
| Professional | | $4,677.35 | $6,918.31 | $14,454.40 |