- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,165.08 / $1,165.08 / $1,501.60
| Facility | | $1,165.08 | $1,165.08 | $1,501.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,040.68 / $1,403.38 / $2,381.31
| Professional | | $1,040.68 | $1,403.38 | $2,381.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,108.34 / $4,751.20 / $7,942.01
| Facility | | $1,108.34 | $4,751.20 | $7,942.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,108.34 / $2,316.44 / $10,139.52
| Professional | | $1,108.34 | $2,316.44 | $10,139.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,210.32 / $1,555.26 / $2,776.47
| Facility | | $1,210.32 | $1,555.26 | $2,776.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,355.03 / $2,157.62 / $3,806.28
| Professional | | $1,355.03 | $2,157.62 | $3,806.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,655.16 / $8,090.00
| Facility | | $300.00 | $1,655.16 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,594.22 / $1,931.13 / $2,642.59
| Professional | | $1,594.22 | $1,931.13 | $2,642.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,320.82 / $2,803.22 / $3,943.12
| Professional | | $1,320.82 | $2,803.22 | $3,943.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,063.00 / $12,850.00
| Facility | | $55.00 | $5,063.00 | $12,850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,618.90 / $3,002.94 / $10,139.52
| Professional | | $1,618.90 | $3,002.94 | $10,139.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $6,204.00 / $13,284.00
| Facility | | $2,324.00 | $6,204.00 | $13,284.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,509.34 / $2,270.51 / $4,977.43
| Professional | | $1,509.34 | $2,270.51 | $4,977.43 |