- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,029.33 / $5,763.83 / $6,347.89
| Facility | | $2,029.33 | $5,763.83 | $6,347.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $814.62 / $1,229.61 / $1,306.47
| Professional | | $814.62 | $1,229.61 | $1,306.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,198.88 / $1,198.88 / $1,198.88
| Professional | | $1,198.88 | $1,198.88 | $1,198.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,029.03 / $1,996.92 / $4,592.68
| Facility | | $1,029.03 | $1,996.92 | $4,592.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,408.44 / $7,408.44 / $7,408.44
| Professional | | $7,408.44 | $7,408.44 | $7,408.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,613.87 / $2,074.98 / $3,796.44
| Professional | | $1,613.87 | $2,074.98 | $3,796.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,365.48 / $6,347.89 / $6,347.89
| Facility | | $2,365.48 | $6,347.89 | $6,347.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,008.75 / $1,306.47 / $6,347.89
| Professional | | $1,008.75 | $1,306.47 | $6,347.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,274.79 / $2,305.53 / $3,074.04
| Professional | | $2,274.79 | $2,305.53 | $3,074.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.99 / $1,942.29 / $5,100.52
| Facility | | $1,070.99 | $1,942.29 | $5,100.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,408.44 / $7,408.44 / $7,408.44
| Professional | | $7,408.44 | $7,408.44 | $7,408.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,537.02 / $1,537.02 / $1,690.72
| Facility | | $1,537.02 | $1,537.02 | $1,690.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,537.02 / $1,537.02 / $1,690.72
| Professional | | $1,537.02 | $1,537.02 | $1,690.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.54 / $922.21 / $2,052.23
| Professional | | $645.54 | $922.21 | $2,052.23 |