- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.13 / $1,127.14 / $1,773.38
| Facility | | $912.13 | $1,127.14 | $1,773.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $893.85 / $1,079.14 / $1,884.71
| Professional | | $893.85 | $1,079.14 | $1,884.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.83 / $1,242.00 / $1,820.99
| Professional | | $933.83 | $1,242.00 | $1,820.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,041.76 / $1,041.76 / $1,041.76
| Facility | | $1,041.76 | $1,041.76 | $1,041.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,097.27 / $1,448.37 / $2,132.73
| Professional | | $1,097.27 | $1,448.37 | $2,132.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $7,806.60
| Facility | | $55.00 | $55.00 | $7,806.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,092.80 / $8,326.08 / $10,178.85
| Professional | | $8,092.80 | $8,326.08 | $10,178.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,010.82 / $1,355.47 / $2,501.42
| Facility | | $1,010.82 | $1,355.47 | $2,501.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,250.33 / $1,739.09 / $2,045.99
| Professional | | $1,250.33 | $1,739.09 | $2,045.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,138.90 / $1,138.90 / $1,138.90
| Professional | | $1,138.90 | $1,138.90 | $1,138.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,043.41 / $1,379.44 / $2,560.42
| Facility | | $1,043.41 | $1,379.44 | $2,560.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,108.35 / $1,494.20 / $2,318.63
| Professional | | $1,108.35 | $1,494.20 | $2,318.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.00 / $1,972.00 / $8,583.00
| Facility | | $405.00 | $1,972.00 | $8,583.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $907.24 / $1,238.92 / $1,916.41
| Professional | | $907.24 | $1,238.92 | $1,916.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $970.11 / $1,108.35 / $1,513.43
| Professional | | $970.11 | $1,108.35 | $1,513.43 |