- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,212.86 / $1,212.86 / $4,828.00
| Facility | | $1,212.86 | $1,212.86 | $4,828.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,142.04 / $1,252.40 / $2,123.98
| Professional | | $1,142.04 | $1,252.40 | $2,123.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,849.35 / $12,222.68 / $24,627.71
| Facility | | $5,849.35 | $12,222.68 | $24,627.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,189.55 / $3,544.43 / $4,624.96
| Professional | | $2,189.55 | $3,544.43 | $4,624.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,995.23 / $4,249.80 / $10,223.46
| Facility | | $2,995.23 | $4,249.80 | $10,223.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,245.91 / $3,577.68 / $5,313.41
| Professional | | $2,245.91 | $3,577.68 | $5,313.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,722.94 / $3,885.34 / $8,049.98
| Facility | | $2,722.94 | $3,885.34 | $8,049.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,033.38 / $3,198.69 / $4,872.71
| Professional | | $2,033.38 | $3,198.69 | $4,872.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.54 / $2,118.91 / $5,331.00
| Facility | | $1,277.54 | $2,118.91 | $5,331.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.81 / $2,480.98 / $5,109.75
| Professional | | $1,380.81 | $2,480.98 | $5,109.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $10,493.00 / $21,186.75
| Facility | | $3,940.00 | $10,493.00 | $21,186.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,456.15 / $2,698.85 / $4,985.78
| Professional | | $1,456.15 | $2,698.85 | $4,985.78 |