- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,190.71 / $1,190.71 / $1,190.71
| Facility | | $1,190.71 | $1,190.71 | $1,190.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,032.45 / $1,190.71 / $1,595.24
| Professional | | $1,032.45 | $1,190.71 | $1,595.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,438.25 / $4,292.35 / $10,228.89
| Facility | | $2,438.25 | $4,292.35 | $10,228.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,064.53 / $2,068.19 / $2,767.77
| Professional | | $1,064.53 | $2,068.19 | $2,767.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,892.50 / $3,519.06 / $4,531.88
| Facility | | $2,892.50 | $3,519.06 | $4,531.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,784.48 / $2,418.00 / $2,418.00
| Professional | | $1,784.48 | $2,418.00 | $2,418.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,367.82 / $1,576.30 / $1,910.50
| Facility | | $1,367.82 | $1,576.30 | $1,910.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $998.51 / $1,367.82 / $2,451.38
| Professional | | $998.51 | $1,367.82 | $2,451.38 |
- 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
- $2,206.46 / $2,206.46 / $2,316.78
| Professional | | $2,206.46 | $2,206.46 | $2,316.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,298.54 / $1,298.54 / $1,298.54
| Professional | | $1,298.54 | $1,298.54 | $1,298.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,292.35 / $10,228.89 / $10,228.89
| Facility | | $4,292.35 | $10,228.89 | $10,228.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,019.68 / $1,456.72 / $2,661.32
| Professional | | $1,019.68 | $1,456.72 | $2,661.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.63 / $849.73 / $1,536.34
| Facility | | $1.63 | $849.73 | $1,536.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,019.68 / $1,456.72 / $2,534.28
| Professional | | $1,019.68 | $1,456.72 | $2,534.28 |