- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,644.54 / $1,644.54 / $1,644.54
| Facility | | $1,644.54 | $1,644.54 | $1,644.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,644.54 / $1,829.37 / $2,410.63
| Professional | | $1,644.54 | $1,829.37 | $2,410.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,487.57 / $7,828.35 / $17,957.82
| Facility | | $2,487.57 | $7,828.35 | $17,957.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,560.53 / $2,693.89 / $3,675.70
| Professional | | $1,560.53 | $2,693.89 | $3,675.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,109.75 / $4,860.35 / $6,259.23
| Facility | | $4,109.75 | $4,860.35 | $6,259.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,464.63 / $2,901.66 / $2,901.66
| Professional | | $2,464.63 | $2,901.66 | $2,901.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,326.75 / $2,326.75 / $2,766.42
| Facility | | $2,326.75 | $2,326.75 | $2,766.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.53 / $2,326.75 / $4,470.75
| Professional | | $1,698.53 | $2,326.75 | $4,470.75 |
- 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
- $3,047.47 / $3,047.47 / $3,199.84
| Professional | | $3,047.47 | $3,047.47 | $3,199.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,288.55 / $2,288.55 / $2,288.55
| Professional | | $2,288.55 | $2,288.55 | $2,288.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,828.35 / $17,957.82 / $17,957.82
| Facility | | $7,828.35 | $17,957.82 | $17,957.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,432.22 / $1,877.77 / $3,675.70
| Professional | | $1,432.22 | $1,877.77 | $3,675.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,456.62 / $2,011.94 / $3,675.70
| Professional | | $1,456.62 | $2,011.94 | $3,675.70 |