- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,240.27 / $1,943.40 / $3,141.26
| Facility | | $1,240.27 | $1,943.40 | $3,141.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,017.29 / $1,138.86 / $1,284.59
| Professional | | $1,017.29 | $1,138.86 | $1,284.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,025.46 / $1,025.46 / $1,025.46
| Professional | | $1,025.46 | $1,025.46 | $1,025.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,073.27 / $1,320.91 / $2,353.60
| Facility | | $1,073.27 | $1,320.91 | $2,353.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $889.12 / $1,415.67 / $2,688.00
| Professional | | $889.12 | $1,415.67 | $2,688.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,199.55 / $1,769.04 / $2,255.48
| Professional | | $1,199.55 | $1,769.04 | $2,255.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,089.36 / $3,684.41 / $13,614.12
| Facility | | $3,089.36 | $3,684.41 | $13,614.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,376.43 / $1,943.40 / $13,402.64
| Facility | | $1,376.43 | $1,943.40 | $13,402.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,020.86 / $1,142.27 / $1,321.08
| Professional | | $1,020.86 | $1,142.27 | $1,321.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,298.20 / $1,459.75 / $2,366.98
| Professional | | $1,298.20 | $1,459.75 | $2,366.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $978.75 / $1,320.91 / $1,961.33
| Facility | | $978.75 | $1,320.91 | $1,961.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $889.12 / $1,415.67 / $3,709.56
| Professional | | $889.12 | $1,415.67 | $3,709.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,295.58 / $1,295.58 / $1,375.00
| Facility | | $1,295.58 | $1,295.58 | $1,375.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $808.56 / $1,295.58 / $1,321.49
| Professional | | $808.56 | $1,295.58 | $1,321.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,361.76 / $2,344.69
| Professional | | $1,000.00 | $1,361.76 | $2,344.69 |