- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,466.84 / $5,495.41
| Facility | | $1,621.81 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $831.76 / $1,445.44
| Professional | | $602.56 | $831.76 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,011.87 / $13,489.63
| Facility | | $1,412.54 | $5,011.87 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,230.27 / $1,288.25
| Professional | | $1,047.13 | $1,230.27 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,000.00 / $1,202.26
| Professional | | $758.58 | $1,000.00 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,318.26 / $4,168.69
| Facility | | $707.95 | $1,318.26 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,096.48 / $1,258.93
| Professional | | $645.65 | $1,096.48 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $11,748.98 / $16,218.10
| Facility | | $8,511.38 | $11,748.98 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,023.29 / $1,230.27
| Professional | | $851.14 | $1,023.29 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $1,096.48 / $12,302.69
| Professional | | $537.03 | $1,096.48 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $12,302.69 / $12,302.69
| Facility | | $5,495.41 | $12,302.69 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $891.25 / $1,288.25
| Professional | | $645.65 | $891.25 | $1,288.25 |