- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,926.94 / $5,115.14 / $14,335.20
| Facility | | $1,926.94 | $5,115.14 | $14,335.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,634.98 / $1,926.94 / $2,423.27
| Professional | | $1,634.98 | $1,926.94 | $2,423.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.98 / $445.25 / $820.63
| Facility | | $210.98 | $445.25 | $820.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,844.60 / $2,084.83 / $8,820.10
| Facility | | $1,844.60 | $2,084.83 | $8,820.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,556.09 / $3,556.09 / $4,260.59
| Professional | | $3,556.09 | $3,556.09 | $4,260.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,671.35 / $13,868.10 / $13,868.10
| Facility | | $4,671.35 | $13,868.10 | $13,868.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,539.61 / $14,539.61 / $21,897.00
| Professional | | $14,539.61 | $14,539.61 | $21,897.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.76 / $2,919.60 / $4,350.20
| Facility | | $1,751.76 | $2,919.60 | $4,350.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,919.60 / $2,919.60 / $3,649.50
| Professional | | $2,919.60 | $2,919.60 | $3,649.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,627.64 / $3,649.50 / $6,569.10
| Professional | | $2,627.64 | $3,649.50 | $6,569.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.76 / $2,797.27 / $4,972.20
| Facility | | $1,751.76 | $2,797.27 | $4,972.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,759.02 / $3,211.56 / $5,109.30
| Professional | | $2,759.02 | $3,211.56 | $5,109.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,226.23 / $1,226.23 / $1,798.47
| Professional | | $1,226.23 | $1,226.23 | $1,798.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.00 / $1,512.35 / $3,297.45
| Professional | | $208.00 | $1,512.35 | $3,297.45 |