- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,830.39 / $1,830.39 / $1,830.39
| Facility | | $1,830.39 | $1,830.39 | $1,830.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,830.39 / $1,830.39 / $2,849.99
| Professional | | $1,830.39 | $1,830.39 | $2,849.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,237.40 / $7,056.76 / $18,435.41
| Facility | | $2,237.40 | $7,056.76 | $18,435.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,805.74 / $2,753.45 / $4,091.06
| Professional | | $1,805.74 | $2,753.45 | $4,091.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,446.45 / $5,409.61 / $6,966.56
| Facility | | $4,446.45 | $5,409.61 | $6,966.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,743.16 / $3,717.02 / $3,717.02
| Professional | | $2,743.16 | $3,717.02 | $3,717.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.15 / $2,782.58 / $2,936.88
| Facility | | $2,423.15 | $2,782.58 | $2,936.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,031.28 / $2,031.28 / $4,986.75
| Professional | | $2,031.28 | $2,031.28 | $4,986.75 |
- 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
- $3,391.85 / $3,391.85 / $3,561.44
| Professional | | $3,391.85 | $3,391.85 | $3,561.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,225.60 / $2,225.60 / $2,225.60
| Professional | | $2,225.60 | $2,225.60 | $2,225.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,731.95 / $18,435.41 / $18,435.41
| Facility | | $8,731.95 | $18,435.41 | $18,435.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,636.42 / $2,239.31 / $4,091.06
| Professional | | $1,636.42 | $2,239.31 | $4,091.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,692.48 / $2,239.31 / $3,463.02
| Professional | | $1,692.48 | $2,239.31 | $3,463.02 |