- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,217.68 / $1,217.68 / $1,217.68
| Facility | | $1,217.68 | $1,217.68 | $1,217.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.09 / $1,217.68 / $1,569.22
| Professional | | $1,148.09 | $1,217.68 | $1,569.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,322.10 / $4,380.12 / $11,870.73
| Facility | | $1,322.10 | $4,380.12 | $11,870.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,021.01 / $1,675.93 / $2,721.60
| Professional | | $1,021.01 | $1,675.93 | $2,721.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,958.02 / $3,598.77 / $4,634.54
| Facility | | $2,958.02 | $3,598.77 | $4,634.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,007.39 / $2,549.53 / $2,549.53
| Professional | | $2,007.39 | $2,549.53 | $2,549.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,306.07 / $1,612.01 / $1,953.79
| Facility | | $1,306.07 | $1,612.01 | $1,953.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $953.43 / $1,306.07 / $2,589.75
| Professional | | $953.43 | $1,306.07 | $2,589.75 |
- 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
- $2,256.44 / $2,256.44 / $2,369.27
| Professional | | $2,256.44 | $2,256.44 | $2,369.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.24 / $1,380.24 / $1,380.24
| Facility | | $1,380.24 | $1,380.24 | $1,380.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,839.86 / $1,839.86 / $1,839.86
| Professional | | $1,839.86 | $1,839.86 | $1,839.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,534.51 / $11,870.73 / $11,870.73
| Facility | | $4,534.51 | $11,870.73 | $11,870.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $926.91 / $1,390.36 / $2,721.60
| Professional | | $926.91 | $1,390.36 | $2,721.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $946.83 / $1,390.36 / $2,721.60
| Professional | | $946.83 | $1,390.36 | $2,721.60 |