- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,715.35 / $12,882.50
| Facility | | $1,000.00 | $3,715.35 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,511.89 / $3,890.45
| Professional | | $2,041.74 | $2,511.89 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,818.38 / $3,801.89
| Professional | | $2,344.23 | $2,818.38 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $2,238.72 / $2,398.83
| Facility | | $79.43 | $2,238.72 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,235.94 / $4,897.79
| Professional | | $2,290.87 | $3,235.94 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,011.87 / $24,547.09
| Facility | | $5,011.87 | $5,011.87 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,595.87 / $21,877.62 / $21,877.62
| Professional | | $16,595.87 | $21,877.62 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,884.03 / $5,370.32
| Facility | | $2,041.74 | $2,884.03 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,019.95 / $4,168.69
| Professional | | $2,041.74 | $3,019.95 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $2,041.74
| Professional | | $32.36 | $33.11 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $4,466.84
| Professional | | $2,570.40 | $2,570.40 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,884.03 / $5,011.87
| Facility | | $2,187.76 | $2,884.03 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,235.94 / $4,897.79
| Professional | | $2,238.72 | $3,235.94 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $2,511.89 / $10,232.93
| Facility | | $446.68 | $2,511.89 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,511.89 / $3,890.45
| Professional | | $1,905.46 | $2,511.89 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,511.89 / $2,511.89
| Professional | | $2,238.72 | $2,511.89 | $2,511.89 |