- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,098.40 / $6,661.56 / $9,682.50
| Facility | | $3,098.40 | $6,661.56 | $9,682.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,711.10 / $3,098.40 / $5,591.06
| Professional | | $2,711.10 | $3,098.40 | $5,591.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,419.86 / $4,182.84 / $6,854.05
| Facility | | $3,419.86 | $4,182.84 | $6,854.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,549.20 / $1,874.53 / $5,371.85
| Professional | | $1,549.20 | $1,874.53 | $5,371.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,873.00 / $4,841.25 / $5,809.50
| Facility | | $3,873.00 | $4,841.25 | $5,809.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,034.89 / $5,228.55 / $9,295.20
| Professional | | $5,034.89 | $5,228.55 | $9,295.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,456.46 / $3,987.64 / $22,103.21
| Facility | | $3,456.46 | $3,987.64 | $22,103.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,872.04 / $3,485.82 / $7,503.74
| Professional | | $1,872.04 | $3,485.82 | $7,503.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,456.46 / $3,987.64 / $22,427.73
| Facility | | $3,456.46 | $3,987.64 | $22,427.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,872.04 / $2,168.88 / $7,503.74
| Professional | | $1,872.04 | $2,168.88 | $7,503.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,049.98 / $3,485.70 / $4,792.83
| Professional | | $3,049.98 | $3,485.70 | $4,792.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,626.66 / $2,323.80 / $5,115.07
| Professional | | $1,626.66 | $2,323.80 | $5,115.07 |