- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.00 / $3,792.00 / $13,401.00
| Facility | | $1,068.00 | $3,792.00 | $13,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,648.22 / $2,137.66 / $4,404.71
| Professional | | $1,648.22 | $2,137.66 | $4,404.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,081.04 / $1,945.87 / $9,033.17
| Facility | | $1,081.04 | $1,945.87 | $9,033.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Facility | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,432.65 / $2,432.65 / $2,432.65
| Facility | | $2,432.65 | $2,432.65 | $2,432.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,989.38 / $3,989.38 / $10,127.93
| Professional | | $3,989.38 | $3,989.38 | $10,127.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,981.46 / $22,004.64 / $22,640.22
| Facility | | $17,981.46 | $22,004.64 | $22,640.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,372.16 / $15,811.92 / $18,419.84
| Professional | | $15,372.16 | $15,811.92 | $18,419.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,973.28 / $2,471.00 / $4,476.76
| Facility | | $1,973.28 | $2,471.00 | $4,476.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,036.60 / $2,036.60 / $2,036.60
| Professional | | $2,036.60 | $2,036.60 | $2,036.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,832.94 / $2,583.42 / $4,476.76
| Facility | | $1,832.94 | $2,583.42 | $4,476.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,036.60 / $3,989.38 / $10,127.93
| Professional | | $2,036.60 | $3,989.38 | $10,127.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $7,123.00 / $16,000.00
| Facility | | $2,600.00 | $7,123.00 | $16,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,235.13 / $2,227.85 / $3,597.63
| Professional | | $1,235.13 | $2,227.85 | $3,597.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.13 / $1,862.13 / $2,513.88
| Professional | | $1,862.13 | $1,862.13 | $2,513.88 |