- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,454.71 / $7,943.28
| Facility | | $1,479.11 | $2,454.71 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,096.48 / $2,570.40
| Professional | | $933.25 | $1,096.48 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,737.80 / $2,570.40
| Professional | | $977.24 | $1,737.80 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,949.84 / $2,398.83
| Professional | | $1,445.44 | $1,949.84 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,479.11 / $2,454.71
| Facility | | $1,000.00 | $1,479.11 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,819.70 / $2,454.71
| Professional | | $1,548.82 | $1,819.70 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,905.46 / $2,041.74
| Facility | | $1,584.89 | $1,905.46 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,479.11 / $2,344.23
| Facility | | $977.24 | $1,479.11 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $1,949.84 / $2,691.53
| Professional | | $79.43 | $1,949.84 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $5,248.07 / $5,248.07
| Facility | | $5,248.07 | $5,248.07 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,089.30 / $2,691.53
| Professional | | $1,862.09 | $2,089.30 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $7,585.78 / $31,622.78
| Facility | | $1,412.54 | $7,585.78 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,949.84 / $2,884.03
| Professional | | $1,230.27 | $1,949.84 | $2,884.03 |