- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,218.59 / $2,151.52 / $3,651.06
| Facility | | $1,218.59 | $2,151.52 | $3,651.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,017.08 / $1,108.35 / $1,303.95
| Professional | | $1,017.08 | $1,108.35 | $1,303.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.33 / $335.33 / $1,330.03
| Professional | | $335.33 | $335.33 | $1,330.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,117.98 / $1,117.98 / $1,117.98
| Facility | | $1,117.98 | $1,117.98 | $1,117.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.13 / $1,117.98 / $1,117.98
| Professional | | $816.13 | $1,117.98 | $1,117.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,110.32 / $2,347.00 / $2,901.10
| Facility | | $1,110.32 | $2,347.00 | $2,901.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $894.38 / $1,902.92 / $6,285.04
| Professional | | $894.38 | $1,902.92 | $6,285.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $1,564.74 / $2,933.89
| Facility | | $294.00 | $1,564.74 | $2,933.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,369.15 / $1,721.21 / $2,829.57
| Professional | | $1,369.15 | $1,721.21 | $2,829.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,108.35 / $1,303.95 / $2,364.44
| Professional | | $1,108.35 | $1,303.95 | $2,364.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,008.61 / $2,727.72 / $2,984.31
| Facility | | $1,008.61 | $2,727.72 | $2,984.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $726.69 / $1,453.37 / $2,705.51
| Professional | | $726.69 | $1,453.37 | $2,705.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.55 / $670.79 / $1,732.87
| Professional | | $469.55 | $670.79 | $1,732.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,303.95 / $1,499.51 / $1,499.51
| Facility | | $1,303.95 | $1,499.51 | $1,499.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,108.35 / $1,303.95 / $1,567.24
| Professional | | $1,108.35 | $1,303.95 | $1,567.24 |