- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,092.67 / $1,092.67 / $1,092.67
| Facility | | $1,092.67 | $1,092.67 | $1,092.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,092.67 / $1,165.49 / $1,856.46
| Professional | | $1,092.67 | $1,165.49 | $1,856.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,271.25 / $4,009.52 / $15,064.29
| Facility | | $1,271.25 | $4,009.52 | $15,064.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,186.65 / $1,828.59 / $2,442.19
| Professional | | $1,186.65 | $1,828.59 | $2,442.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.34 / $3,229.30 / $4,158.72
| Facility | | $2,654.34 | $3,229.30 | $4,158.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,801.31 / $2,218.91 / $2,218.91
| Professional | | $1,801.31 | $2,218.91 | $2,218.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,446.51 / $1,486.28 / $1,753.20
| Facility | | $1,446.51 | $1,486.28 | $1,753.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,084.98 / $1,486.28 / $3,511.13
| Professional | | $1,084.98 | $1,486.28 | $3,511.13 |
- 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
- $2,024.79 / $2,024.79 / $2,126.03
| Professional | | $2,024.79 | $2,024.79 | $2,126.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,655.23 / $1,655.23 / $1,655.23
| Professional | | $1,655.23 | $1,655.23 | $1,655.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,148.12 / $15,064.29 / $15,064.29
| Facility | | $6,148.12 | $15,064.29 | $15,064.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $988.88 / $1,336.78 / $2,442.19
| Professional | | $988.88 | $1,336.78 | $2,442.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,428.89 / $1,428.89 / $1,428.89
| Facility | | $1,428.89 | $1,428.89 | $1,428.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $976.88 / $1,336.78 / $2,378.58
| Professional | | $976.88 | $1,336.78 | $2,378.58 |