- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,077.00 / $3,682.00 / $12,377.00
| Facility | | $1,077.00 | $3,682.00 | $12,377.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,025.21 / $2,496.87 / $3,831.75
| Professional | | $2,025.21 | $2,496.87 | $3,831.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,459.05 / $3,044.65 / $3,426.74
| Professional | | $2,459.05 | $3,044.65 | $3,426.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,311.37 / $2,311.37 / $2,360.71
| Facility | | $2,311.37 | $2,311.37 | $2,360.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,515.26 / $3,162.39 / $4,730.80
| Professional | | $2,515.26 | $3,162.39 | $4,730.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,000.00 / $18,395.93
| Facility | | $55.00 | $2,000.00 | $18,395.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,368.56 / $19,758.32 / $22,876.73
| Professional | | $19,368.56 | $19,758.32 | $22,876.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.94 / $2,976.87 / $3,984.96
| Facility | | $2,386.94 | $2,976.87 | $3,984.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,628.80 / $3,943.20 / $5,257.60
| Professional | | $2,628.80 | $3,943.20 | $5,257.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.94 / $2,976.87 / $4,141.33
| Facility | | $2,386.94 | $2,976.87 | $4,141.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,554.50 / $3,350.00 / $5,258.38
| Professional | | $2,554.50 | $3,350.00 | $5,258.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $745.00 / $2,494.00 / $4,764.00
| Facility | | $745.00 | $2,494.00 | $4,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,126.13 / $2,834.84 / $4,067.19
| Professional | | $2,126.13 | $2,834.84 | $4,067.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,243.60 / $2,554.50 / $3,538.26
| Professional | | $2,243.60 | $2,554.50 | $3,538.26 |