- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,886.12 / $1,886.12 / $1,886.12
| Facility | | $1,886.12 | $1,886.12 | $1,886.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,886.12 / $1,989.26 / $3,434.97
| Professional | | $1,886.12 | $1,989.26 | $3,434.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,862.24 / $11,528.79 / $20,671.75
| Facility | | $3,862.24 | $11,528.79 | $20,671.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,946.45 / $3,126.16 / $4,215.60
| Professional | | $1,946.45 | $3,126.16 | $4,215.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,713.42 / $5,574.29 / $7,178.63
| Facility | | $4,713.42 | $5,574.29 | $7,178.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,109.32 / $3,628.59 / $3,628.59
| Professional | | $3,109.32 | $3,628.59 | $3,628.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,026.28 / $3,060.59 / $3,172.77
| Facility | | $3,026.28 | $3,060.59 | $3,172.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,234.23 / $2,234.23 / $5,127.38
| Professional | | $2,234.23 | $2,234.23 | $5,127.38 |
- 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
- $3,495.10 / $3,495.10 / $3,669.86
| Professional | | $3,495.10 | $3,495.10 | $3,669.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,180.12 / $5,180.12 / $5,180.12
| Facility | | $5,180.12 | $5,180.12 | $5,180.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,978.18 / $20,671.75 / $20,671.75
| Facility | | $8,978.18 | $20,671.75 | $20,671.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,784.24 / $2,307.46 / $4,215.60
| Professional | | $1,784.24 | $2,307.46 | $4,215.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,874.82 / $2,315.03 / $4,215.60
| Professional | | $1,874.82 | $2,315.03 | $4,215.60 |