- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $986.86 / $2,287.00 / $6,409.37
| Facility | | $986.86 | $2,287.00 | $6,409.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $783.22 / $992.08 / $1,266.21
| Professional | | $783.22 | $992.08 | $1,266.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,109.56 / $1,305.36 / $1,305.36
| Professional | | $1,109.56 | $1,305.36 | $1,305.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,305.36 / $1,305.36 / $1,305.36
| Facility | | $1,305.36 | $1,305.36 | $1,305.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $859.10 / $2,850.93 / $5,815.93
| Facility | | $859.10 | $2,850.93 | $5,815.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,500.02 / $1,590.88 / $1,988.60
| Professional | | $1,500.02 | $1,590.88 | $1,988.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.59 / $6,200.51 / $6,200.51
| Facility | | $2,088.59 | $6,200.51 | $6,200.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.38 / $1,305.36 / $1,435.91
| Facility | | $822.38 | $1,305.36 | $1,435.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.83 / $1,305.36 / $1,305.36
| Professional | | $1,174.83 | $1,305.36 | $1,305.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $861.54 / $1,305.36 / $1,909.10
| Facility | | $861.54 | $1,305.36 | $1,909.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,005.13 / $1,240.09 / $1,377.17
| Professional | | $1,005.13 | $1,240.09 | $1,377.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.26 / $548.26 / $783.22
| Professional | | $548.26 | $548.26 | $783.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $627.03 / $1,148.40 / $1,305.36
| Professional | | $627.03 | $1,148.40 | $1,305.36 |