- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,105.63 / $1,105.63 / $1,105.63
| Facility | | $1,105.63 | $1,105.63 | $1,105.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,105.63 / $1,109.16 / $1,907.74
| Professional | | $1,105.63 | $1,109.16 | $1,907.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,322.10 / $4,380.12 / $14,424.99
| Facility | | $1,322.10 | $4,380.12 | $14,424.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,031.73 / $1,802.14 / $2,471.17
| Professional | | $1,031.73 | $1,802.14 | $2,471.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,685.84 / $3,267.63 / $4,208.10
| Facility | | $2,685.84 | $3,267.63 | $4,208.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,822.68 / $1,950.79 / $1,950.79
| Professional | | $1,822.68 | $1,950.79 | $1,950.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,463.68 / $1,703.99 / $1,774.00
| Facility | | $1,463.68 | $1,703.99 | $1,774.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,243.91 / $1,703.99 / $2,780.63
| Professional | | $1,243.91 | $1,703.99 | $2,780.63 |
- 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
- $2,048.82 / $2,048.82 / $2,151.26
| Professional | | $2,048.82 | $2,048.82 | $2,151.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,657.05 / $1,657.05 / $1,657.05
| Professional | | $1,657.05 | $1,657.05 | $1,657.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,869.16 / $14,424.99 / $14,424.99
| Facility | | $4,869.16 | $14,424.99 | $14,424.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $946.91 / $1,262.43 / $2,471.17
| Professional | | $946.91 | $1,262.43 | $2,471.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,520.62 / $1,520.62 / $1,520.62
| Facility | | $1,520.62 | $1,520.62 | $1,520.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $988.47 / $1,351.61 / $2,277.63
| Professional | | $988.47 | $1,351.61 | $2,277.63 |