- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,177.55 / $1,177.55 / $1,177.55
| Facility | | $1,177.55 | $1,177.55 | $1,177.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,177.55 / $1,241.94 / $2,144.58
| Professional | | $1,177.55 | $1,241.94 | $2,144.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,411.30 / $7,197.73 / $12,858.35
| Facility | | $2,411.30 | $7,197.73 | $12,858.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.61 / $2,002.05 / $2,631.91
| Professional | | $1,230.61 | $2,002.05 | $2,631.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,942.72 / $3,480.18 / $4,481.82
| Facility | | $2,942.72 | $3,480.18 | $4,481.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,941.24 / $2,265.42 / $2,265.42
| Professional | | $1,941.24 | $2,265.42 | $2,265.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,786.24 / $1,786.24 / $1,786.24
| Facility | | $1,786.24 | $1,786.24 | $1,786.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,303.96 / $1,786.24 / $3,201.00
| Professional | | $1,303.96 | $1,786.24 | $3,201.00 |
- 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
- $2,182.08 / $2,182.08 / $2,291.17
| Professional | | $2,182.08 | $2,182.08 | $2,291.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,052.11 / $2,052.11 / $2,052.11
| Professional | | $2,052.11 | $2,052.11 | $2,052.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,605.38 / $12,858.35 / $12,858.35
| Facility | | $5,605.38 | $12,858.35 | $12,858.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,052.76 / $1,440.62 / $2,631.91
| Professional | | $1,052.76 | $1,440.62 | $2,631.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,170.51 / $1,440.62 / $2,631.91
| Professional | | $1,170.51 | $1,440.62 | $2,631.91 |