- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,305.54 / $1,305.54 / $1,305.54
| Facility | | $1,305.54 | $1,305.54 | $1,305.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,256.11 / $1,305.54 / $1,566.65
| Professional | | $1,256.11 | $1,305.54 | $1,566.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,710.73 / $2,482.41 / $13,896.60
| Facility | | $1,710.73 | $2,482.41 | $13,896.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $976.19 / $1,817.65 / $2,335.14
| Professional | | $976.19 | $1,817.65 | $2,335.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.20 / $346.20 / $356.29
| Facility | | $346.20 | $346.20 | $356.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,886.08 / $2,693.58 / $2,693.58
| Professional | | $1,886.08 | $2,693.58 | $2,693.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,219.64 / $1,219.64 / $2,915.20
| Facility | | $1,219.64 | $1,219.64 | $2,915.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.74 / $1,219.64 / $4,331.25
| Professional | | $221.74 | $1,219.64 | $4,331.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,436.60 / $2,436.60 / $2,436.60
| Professional | | $2,436.60 | $2,436.60 | $2,436.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,710.48 / $1,710.48 / $2,329.77
| Professional | | $1,710.48 | $1,710.48 | $2,329.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $13,896.60 / $13,896.60
| Facility | | $100.00 | $13,896.60 | $13,896.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $953.31 / $1,497.86 / $2,009.70
| Professional | | $953.31 | $1,497.86 | $2,009.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $953.31 / $1,507.28 / $2,871.69
| Professional | | $953.31 | $1,507.28 | $2,871.69 |