- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.00 / $2,894.76 / $6,107.00
| Facility | | $2,528.00 | $2,894.76 | $6,107.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,254.14 / $1,496.20 / $2,116.92
| Professional | | $1,254.14 | $1,496.20 | $2,116.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,672.00 / $5,268.00 / $10,138.40
| Facility | | $1,672.00 | $5,268.00 | $10,138.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,208.33 / $1,876.02 / $9,961.04
| Professional | | $1,208.33 | $1,876.02 | $9,961.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $974.02 / $974.02 / $2,160.52
| Professional | | $974.02 | $974.02 | $2,160.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,082.51 / $2,082.51 / $2,082.51
| Facility | | $2,082.51 | $2,082.51 | $2,082.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,256.72 / $2,417.37 / $4,128.14
| Professional | | $1,256.72 | $2,417.37 | $4,128.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.49 / $2,248.67 / $6,679.00
| Facility | | $1,375.49 | $2,248.67 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,519.92 / $1,911.38 / $2,638.45
| Professional | | $1,519.92 | $1,911.38 | $2,638.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,680.18 / $3,383.88 / $6,292.69
| Professional | | $1,680.18 | $3,383.88 | $6,292.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $6,104.00 / $26,542.00
| Facility | | $2,155.00 | $6,104.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,293.73 / $1,884.02 / $9,961.04
| Professional | | $1,293.73 | $1,884.02 | $9,961.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,402.00 / $8,810.00
| Facility | | $2,155.00 | $4,402.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,292.59 / $1,695.95 / $4,078.75
| Professional | | $1,292.59 | $1,695.95 | $4,078.75 |