- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,377.87 / $1,404.88 / $1,431.90
| Facility | | $1,377.87 | $1,404.88 | $1,431.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,296.82 / $1,431.90 / $2,323.46
| Professional | | $1,296.82 | $1,431.90 | $2,323.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,456.92 / $5,821.21 / $8,577.84
| Facility | | $5,456.92 | $5,821.21 | $8,577.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,468.38 / $1,837.16 / $1,837.16
| Professional | | $1,468.38 | $1,837.16 | $1,837.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,085.42 / $3,085.42 / $3,085.42
| Facility | | $3,085.42 | $3,085.42 | $3,085.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,815.81 / $1,815.81 / $1,815.81
| Facility | | $1,815.81 | $1,815.81 | $1,815.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,325.54 / $1,325.54 / $1,815.81
| Professional | | $1,325.54 | $1,325.54 | $1,815.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,537.62 / $15,138.02 / $18,404.34
| Facility | | $6,537.62 | $15,138.02 | $18,404.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,962.96 / $19,418.09 / $22,132.73
| Professional | | $18,962.96 | $19,418.09 | $22,132.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $935.93 / $2,150.23 / $3,085.42
| Facility | | $935.93 | $2,150.23 | $3,085.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $935.93 / $2,838.59 / $3,097.55
| Professional | | $935.93 | $2,838.59 | $3,097.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $935.93 / $2,061.59 / $3,085.42
| Facility | | $935.93 | $2,061.59 | $3,085.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,325.54 / $1,325.54 / $1,935.74
| Professional | | $1,325.54 | $1,325.54 | $1,935.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,208.11 / $1,747.07 / $2,079.84
| Professional | | $1,208.11 | $1,747.07 | $2,079.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,718.05 / $1,740.96 / $3,085.42
| Professional | | $1,718.05 | $1,740.96 | $3,085.42 |