- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,888.44 / $10,964.78
| Facility | | $1,819.70 | $5,888.44 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,819.70 / $3,467.37
| Professional | | $1,548.82 | $1,819.70 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,760.83 / $7,413.10
| Facility | | $5,888.44 | $6,760.83 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,511.89 / $4,365.16
| Professional | | $1,698.24 | $2,511.89 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,691.53 / $12,022.64
| Professional | | $1,819.70 | $2,691.53 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,995.26 / $3,715.35
| Professional | | $1,122.02 | $1,995.26 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,905.46 / $2,290.87
| Professional | | $1,513.56 | $1,905.46 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,905.46 / $4,073.80
| Professional | | $1,202.26 | $1,905.46 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,089.30 / $3,311.31
| Facility | | $1,288.25 | $2,089.30 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $1,258.93
| Professional | | $1,258.93 | $1,258.93 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,089.30 / $10,000.00
| Facility | | $1,023.29 | $2,089.30 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,089.30 / $10,000.00
| Professional | | $1,023.29 | $2,089.30 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $12,882.50 / $29,512.09
| Facility | | $7,413.10 | $12,882.50 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,584.89 / $3,388.44
| Professional | | $851.14 | $1,584.89 | $3,388.44 |