- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $9,549.93 / $18,197.01
| Facility | | $7,244.36 | $9,549.93 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,737.80 / $1,862.09
| Professional | | $1,258.93 | $1,737.80 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $6,309.57 / $12,302.69
| Facility | | $4,786.30 | $6,309.57 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $147.91 / $208.93
| Professional | | $87.10 | $147.91 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,548.13 / $4,265.80
| Professional | | $2,187.76 | $3,548.13 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,311.31 / $23,988.33
| Facility | | $1,737.80 | $3,311.31 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,630.78 / $5,248.07
| Professional | | $2,691.53 | $3,630.78 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,548.13 / $4,265.80
| Professional | | $2,187.76 | $3,548.13 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,890.45 / $4,265.80
| Professional | | $3,162.28 | $3,890.45 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.10 / $15,848.93 / $45,708.82
| Facility | | $87.10 | $15,848.93 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,548.13 / $4,677.35
| Professional | | $2,238.72 | $3,548.13 | $4,677.35 |