- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,028.46 / $1,028.46 / $1,028.46
| Facility | | $1,028.46 | $1,028.46 | $1,028.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.46 / $1,084.70 / $1,873.01
| Professional | | $1,028.46 | $1,084.70 | $1,873.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,106.01 / $6,286.44 / $11,271.87
| Facility | | $2,106.01 | $6,286.44 | $11,271.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,074.80 / $1,748.56 / $2,298.69
| Professional | | $1,074.80 | $1,748.56 | $2,298.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.14 / $3,039.56 / $3,914.38
| Facility | | $2,570.14 | $3,039.56 | $3,914.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,695.45 / $2,088.52 / $2,088.52
| Professional | | $1,695.45 | $2,088.52 | $2,088.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.19 / $1,411.04 / $1,650.18
| Facility | | $1,346.19 | $1,411.04 | $1,650.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $982.72 / $1,346.19 / $2,796.00
| Professional | | $982.72 | $1,346.19 | $2,796.00 |
- 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
- $1,905.81 / $1,905.81 / $2,001.10
| Professional | | $1,905.81 | $1,905.81 | $2,001.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,405.90 / $1,405.90 / $1,405.90
| Professional | | $1,405.90 | $1,405.90 | $1,405.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,895.63 / $11,271.87 / $11,271.87
| Facility | | $4,895.63 | $11,271.87 | $11,271.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $919.48 / $1,258.22 / $2,298.69
| Professional | | $919.48 | $1,258.22 | $2,298.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,011.71 / $1,258.22 / $2,298.69
| Professional | | $1,011.71 | $1,258.22 | $2,298.69 |