- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,225.50 / $1,225.50 / $19,193.80
| Facility | | $1,225.50 | $1,225.50 | $19,193.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,199.33 / $1,248.41 / $2,001.77
| Professional | | $1,199.33 | $1,248.41 | $2,001.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $5,272.13 / $10,344.08
| Facility | | $2,088.76 | $5,272.13 | $10,344.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,178.86 / $3,505.27 / $4,573.85
| Professional | | $2,178.86 | $3,505.27 | $4,573.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,969.98 / $4,213.97 / $10,137.27
| Facility | | $2,969.98 | $4,213.97 | $10,137.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,229.02 / $3,550.78 / $5,273.45
| Professional | | $2,229.02 | $3,550.78 | $5,273.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,699.98 / $3,852.58 / $7,982.10
| Facility | | $2,699.98 | $3,852.58 | $7,982.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,018.08 / $3,174.63 / $4,836.06
| Professional | | $2,018.08 | $3,174.63 | $4,836.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,267.66 / $2,099.81 / $3,605.12
| Facility | | $1,267.66 | $2,099.81 | $3,605.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,344.52 / $2,414.92 / $4,939.47
| Professional | | $1,344.52 | $2,414.92 | $4,939.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $9,370.00 / $12,774.00
| Facility | | $5,457.00 | $9,370.00 | $12,774.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,316.47 / $2,273.90 / $4,764.56
| Professional | | $1,316.47 | $2,273.90 | $4,764.56 |