- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,610.69 / $2,747.00 / $7,920.26
| Facility | | $1,610.69 | $2,747.00 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $716.96 / $1,067.36 / $4,221.79
| Professional | | $716.96 | $1,067.36 | $4,221.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,099.32 / $1,650.47 / $2,371.91
| Professional | | $1,099.32 | $1,650.47 | $2,371.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,255.33 / $1,768.91 / $2,013.67
| Professional | | $1,255.33 | $1,768.91 | $2,013.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $767.11 / $1,579.94 / $2,350.10
| Facility | | $767.11 | $1,579.94 | $2,350.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,291.59 / $1,728.83 / $2,567.55
| Professional | | $1,291.59 | $1,728.83 | $2,567.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,159.20 / $1,529.24 / $1,647.64
| Facility | | $1,159.20 | $1,529.24 | $1,647.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,067.36 / $1,952.90 / $2,350.10
| Facility | | $1,067.36 | $1,952.90 | $2,350.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,441.93 / $1,904.25 / $2,488.48
| Professional | | $1,441.93 | $1,904.25 | $2,488.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,333.39 / $4,333.39 / $4,333.39
| Facility | | $4,333.39 | $4,333.39 | $4,333.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,485.91 / $1,954.79 / $2,574.96
| Professional | | $1,485.91 | $1,954.79 | $2,574.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,364.00 / $8,571.00 / $36,803.00
| Facility | | $2,364.00 | $8,571.00 | $36,803.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,279.42 / $1,783.40 / $2,570.36
| Professional | | $1,279.42 | $1,783.40 | $2,570.36 |