- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,555.77 / $34,464.37 / $34,464.37
| Facility | | $1,555.77 | $34,464.37 | $34,464.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $935.09 / $1,555.77 / $1,555.77
| Professional | | $935.09 | $1,555.77 | $1,555.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,594.90 / $3,100.62 / $3,818.50
| Facility | | $2,594.90 | $3,100.62 | $3,818.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,455.25 / $1,567.71 / $1,672.22
| Professional | | $1,455.25 | $1,567.71 | $1,672.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.90 / $1,650.90 / $1,650.90
| Facility | | $1,650.90 | $1,650.90 | $1,650.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,403.27 / $1,650.90 / $2,410.13
| Professional | | $1,403.27 | $1,650.90 | $2,410.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $926.42 / $1,741.50 / $3,354.53
| Facility | | $926.42 | $1,741.50 | $3,354.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,432.27 / $2,432.27 / $2,432.27
| Professional | | $2,432.27 | $2,432.27 | $2,432.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,435.00 / $2,435.00 / $5,797.00
| Professional | | $2,435.00 | $2,435.00 | $5,797.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,083.54 / $1,270.60 / $2,211.31
| Facility | | $1,083.54 | $1,270.60 | $2,211.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $926.78 / $1,492.90 / $2,211.31
| Professional | | $926.78 | $1,492.90 | $2,211.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,492.72 / $9,683.48 / $9,683.48
| Facility | | $3,492.72 | $9,683.48 | $9,683.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,487.98 / $15,218.63 / $15,218.63
| Professional | | $10,487.98 | $15,218.63 | $15,218.63 |