- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,326.80 / $1,326.80 / $1,326.80
| Facility | | $1,326.80 | $1,326.80 | $1,326.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,171.19 / $1,326.80 / $1,914.49
| Professional | | $1,171.19 | $1,326.80 | $1,914.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,830.60 / $5,359.97 / $14,424.18
| Facility | | $1,830.60 | $5,359.97 | $14,424.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,243.76 / $1,922.13 / $2,965.49
| Professional | | $1,243.76 | $1,922.13 | $2,965.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,223.10 / $3,921.28 / $5,049.85
| Facility | | $3,223.10 | $3,921.28 | $5,049.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,988.43 / $2,694.37 / $2,694.37
| Professional | | $1,988.43 | $2,694.37 | $2,694.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,654.54 / $1,756.46 / $2,128.86
| Facility | | $1,654.54 | $1,756.46 | $2,128.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,207.81 / $1,654.54 / $2,780.63
| Professional | | $1,207.81 | $1,654.54 | $2,780.63 |
- 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
- $2,458.65 / $2,458.65 / $2,581.58
| Professional | | $2,458.65 | $2,458.65 | $2,581.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,446.97 / $1,446.97 / $1,446.97
| Professional | | $1,446.97 | $1,446.97 | $1,446.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,359.97 / $14,424.18 / $14,424.18
| Facility | | $5,359.97 | $14,424.18 | $14,424.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,136.22 / $1,623.21 / $2,965.49
| Professional | | $1,136.22 | $1,623.21 | $2,965.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,247.03 / $1,822.00 / $2,458.65
| Professional | | $1,247.03 | $1,822.00 | $2,458.65 |