- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.22 / $3,707.08 / $3,707.08
| Facility | | $1,078.22 | $3,707.08 | $3,707.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $753.85 / $982.11 / $1,184.23
| Professional | | $753.85 | $982.11 | $1,184.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $778.76 / $1,241.88 / $3,177.99
| Professional | | $778.76 | $1,241.88 | $3,177.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,615.94 / $3,056.95 / $4,689.43
| Facility | | $2,615.94 | $3,056.95 | $4,689.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $953.98 / $2,243.14 / $2,879.85
| Professional | | $953.98 | $2,243.14 | $2,879.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $771.29 / $1,016.37 / $1,810.10
| Facility | | $771.29 | $1,016.37 | $1,810.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $809.55 / $1,041.90 / $1,987.59
| Facility | | $809.55 | $1,041.90 | $1,987.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $832.59 / $1,372.29 / $6,762.49
| Professional | | $832.59 | $1,372.29 | $6,762.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $586.01 / $959.94 / $2,011.11
| Professional | | $586.01 | $959.94 | $2,011.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $763.93 / $1,016.37 / $1,823.00
| Facility | | $763.93 | $1,016.37 | $1,823.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,495.63 / $2,280.61 / $3,279.10
| Professional | | $1,495.63 | $2,280.61 | $3,279.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,147.68 / $2,006.08 / $4,512.68
| Facility | | $1,147.68 | $2,006.08 | $4,512.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,017.70 / $4,276.80 / $6,762.49
| Professional | | $1,017.70 | $4,276.80 | $6,762.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,119.50 / $1,529.86 / $3,500.23
| Professional | | $1,119.50 | $1,529.86 | $3,500.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $797.14 / $1,239.13 / $2,944.53
| Professional | | $797.14 | $1,239.13 | $2,944.53 |