- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,168.69 / $6,165.95
| Facility | | $1,778.28 | $4,168.69 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,698.24 / $2,187.76
| Professional | | $1,202.26 | $1,698.24 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $2,187.76
| Professional | | $512.86 | $512.86 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,090.30 / $7,943.28
| Facility | | $1,445.44 | $3,090.30 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $10,715.19 / $10,715.19
| Professional | | $2,187.76 | $10,715.19 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,630.78 / $8,511.38
| Facility | | $2,187.76 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,691.53 / $4,265.80
| Professional | | $1,548.82 | $2,691.53 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,187.76 / $3,890.45
| Professional | | $1,862.09 | $2,187.76 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,168.69 / $50,118.72
| Facility | | $2,884.03 | $4,168.69 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,238.72
| Professional | | $2,187.76 | $2,187.76 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,187.76 / $2,630.27
| Facility | | $1,995.26 | $2,187.76 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,318.26 / $2,884.03
| Professional | | $933.25 | $1,318.26 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,187.76 / $2,511.89
| Facility | | $1,862.09 | $2,187.76 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,187.76 / $4,365.16
| Professional | | $1,513.56 | $2,187.76 | $4,365.16 |