- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $5,370.32 / $5,370.32
| Facility | | $5,370.32 | $5,370.32 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,445.44 / $1,659.59
| Professional | | $1,230.27 | $1,445.44 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $338.84 / $6,606.93
| Professional | | $288.40 | $338.84 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $6,309.57 / $10,000.00
| Facility | | $5,370.32 | $6,309.57 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,466.84 / $6,025.60
| Professional | | $2,238.72 | $4,466.84 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $7,413.10 / $11,220.18
| Facility | | $2,089.30 | $7,413.10 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,748.98 / $11,748.98 / $12,882.50
| Professional | | $11,748.98 | $11,748.98 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,344.23 / $6,760.83
| Facility | | $1,584.89 | $2,344.23 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,047.13 / $9,772.37
| Professional | | $794.33 | $1,047.13 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $58.88 / $85.11
| Professional | | $50.12 | $58.88 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,570.88 / $6,456.54
| Professional | | $3,162.28 | $4,570.88 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $9,332.54 / $9,332.54
| Facility | | $3,890.45 | $9,332.54 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,762.47 / $9,772.37
| Professional | | $2,818.38 | $7,762.47 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $3,715.35
| Professional | | $3,715.35 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,623.41 / $10,715.19 / $13,489.63
| Professional | | $5,623.41 | $10,715.19 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,412.54 / $2,344.23
| Facility | | $1,412.54 | $1,412.54 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,047.13 / $2,884.03
| Professional | | $741.31 | $1,047.13 | $2,884.03 |