- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $5,011.87 / $9,332.54
| Facility | | $2,691.53 | $5,011.87 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,548.82 / $5,370.32
| Professional | | $1,000.00 | $1,548.82 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,918.31 / $27,542.29
| Facility | | $2,570.40 | $6,918.31 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,659.59 / $7,943.28
| Professional | | $954.99 | $1,659.59 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,311.31 / $3,467.37
| Professional | | $1,819.70 | $3,311.31 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,949.84 / $3,715.35
| Professional | | $1,047.13 | $1,949.84 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,995.26 / $7,079.46
| Facility | | $707.95 | $1,995.26 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,122.02 / $1,659.59
| Professional | | $588.84 | $1,122.02 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,918.31 / $15,488.17
| Facility | | $2,570.40 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,905.46 / $3,090.30
| Professional | | $1,174.90 | $1,905.46 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $7,244.36 / $9,332.54
| Facility | | $7,244.36 | $7,244.36 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $7,244.36 / $50,118.72
| Facility | | $2,630.27 | $7,244.36 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,621.81 / $7,943.28
| Professional | | $954.99 | $1,621.81 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $7,244.36 / $19,054.61
| Facility | | $2,570.40 | $7,244.36 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,737.80 / $4,168.69
| Professional | | $1,174.90 | $1,737.80 | $4,168.69 |