- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,715.35 / $6,456.54
| Facility | | $2,570.40 | $3,715.35 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,000.00 / $2,137.96
| Professional | | $776.25 | $1,000.00 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,265.80 / $12,589.25
| Facility | | $1,698.24 | $4,265.80 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,202.26 / $6,165.95
| Professional | | $741.31 | $1,202.26 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $2,691.53 / $2,691.53
| Professional | | $977.24 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,513.56 / $2,754.23
| Professional | | $724.44 | $1,513.56 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,584.89 / $7,079.46
| Facility | | $741.31 | $1,584.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,047.13 / $1,412.54
| Professional | | $812.83 | $1,047.13 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,981.07 / $9,772.37
| Facility | | $1,698.24 | $3,981.07 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,318.26 / $2,398.83
| Professional | | $776.25 | $1,318.26 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,570.88 / $12,589.25
| Facility | | $1,905.46 | $4,570.88 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,174.90 / $6,165.95
| Professional | | $724.44 | $1,174.90 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,265.80 / $10,471.29
| Facility | | $1,698.24 | $4,265.80 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,174.90 / $2,398.83
| Professional | | $812.83 | $1,174.90 | $2,398.83 |