- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $3,388.44 / $5,623.41
| Facility | | $1,202.26 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,137.96 / $7,585.78
| Professional | | $1,202.26 | $2,137.96 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,388.44 / $5,888.44
| Facility | | $56.23 | $3,388.44 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,754.23 / $7,585.78
| Professional | | $1,288.25 | $2,754.23 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,467.37 / $6,165.95
| Professional | | $2,187.76 | $3,467.37 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,511.89 / $8,511.38
| Facility | | $1,584.89 | $2,511.89 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,238.72 / $4,265.80
| Professional | | $1,819.70 | $2,238.72 | $4,265.80 |
- 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
- $1,659.59 / $2,454.71 / $4,365.16
| Professional | | $1,659.59 | $2,454.71 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,467.37 / $7,244.36
| Facility | | $56.23 | $3,467.37 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,754.23 / $7,585.78
| Professional | | $1,288.25 | $2,754.23 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,884.03 / $4,677.35
| Facility | | $1,000.00 | $2,884.03 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,090.30 / $5,370.32
| Professional | | $1,949.84 | $3,090.30 | $5,370.32 |