- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.53 / $8,355.33 / $19,276.96
| Facility | | $1,650.53 | $8,355.33 | $19,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $689.84 / $689.84 / $1,913.80
| Professional | | $689.84 | $689.84 | $1,913.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,860.00 / $10,338.04 / $19,997.13
| Facility | | $7,860.00 | $10,338.04 | $19,997.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $668.25 / $1,139.06 / $1,518.76
| Professional | | $668.25 | $1,139.06 | $1,518.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,114.64 / $7,114.64 / $7,114.64
| Facility | | $7,114.64 | $7,114.64 | $7,114.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,078.00 / $1,662.35 / $2,219.84
| Professional | | $1,078.00 | $1,662.35 | $2,219.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $689.84 / $1,207.22 / $9,496.00
| Facility | | $689.84 | $1,207.22 | $9,496.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.12 / $1,508.50 / $2,070.88
| Professional | | $912.12 | $1,508.50 | $2,070.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $1,730.56 / $8,537.56
| Facility | | $1,089.00 | $1,730.56 | $8,537.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,252.00 / $1,525.50 / $2,219.84
| Professional | | $1,252.00 | $1,525.50 | $2,219.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $754.16 / $1,376.02 / $9,881.48
| Professional | | $754.16 | $1,376.02 | $9,881.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.12 / $1,535.48 / $1,964.56
| Professional | | $912.12 | $1,535.48 | $1,964.56 |