- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,237.45 / $1,237.45 / $1,237.45
| Facility | | $1,237.45 | $1,237.45 | $1,237.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,237.45 / $1,237.45 / $1,594.70
| Professional | | $1,237.45 | $1,237.45 | $1,594.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,533.96 / $8,067.78 / $12,032.65
| Facility | | $2,533.96 | $8,067.78 | $12,032.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $957.77 / $2,027.03 / $2,765.78
| Professional | | $957.77 | $2,027.03 | $2,765.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,092.40 / $3,657.21 / $4,709.79
| Facility | | $3,092.40 | $3,657.21 | $4,709.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,039.97 / $2,039.97 / $2,596.75
| Professional | | $2,039.97 | $2,039.97 | $2,596.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,327.28 / $1,327.28 / $2,081.61
| Facility | | $1,327.28 | $1,327.28 | $2,081.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $968.91 / $1,327.28 / $2,858.25
| Professional | | $968.91 | $1,327.28 | $2,858.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,293.08 / $2,293.08 / $2,407.73
| Professional | | $2,293.08 | $2,293.08 | $2,407.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,675.43 / $1,675.43 / $1,675.43
| Professional | | $1,675.43 | $1,675.43 | $1,675.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,004.92 / $12,032.65 / $12,032.65
| Facility | | $5,004.92 | $12,032.65 | $12,032.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.48 / $1,412.93 / $2,765.78
| Professional | | $816.48 | $1,412.93 | $2,765.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,832.16 / $2,832.16 / $2,832.16
| Facility | | $2,832.16 | $2,832.16 | $2,832.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $898.13 / $1,412.93 / $2,293.08
| Professional | | $898.13 | $1,412.93 | $2,293.08 |