- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,810.13 / $8,477.27 / $20,928.72
| Facility | | $1,810.13 | $8,477.27 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,684.41 / $1,810.13 / $1,810.13
| Professional | | $1,684.41 | $1,810.13 | $1,810.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,619.76 / $8,706.79 / $16,841.75
| Facility | | $6,619.76 | $8,706.79 | $16,841.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.86 / $908.77 / $3,624.86
| Professional | | $399.86 | $908.77 | $3,624.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,266.26 / $5,266.26 / $5,266.26
| Facility | | $5,266.26 | $5,266.26 | $5,266.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,227.88 / $2,908.30 / $4,348.89
| Professional | | $2,227.88 | $2,908.30 | $4,348.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,629.12 / $3,136.73 / $10,325.34
| Facility | | $1,629.12 | $3,136.73 | $10,325.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,469.01 / $2,906.94 / $5,426.29
| Professional | | $1,469.01 | $2,906.94 | $5,426.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,295.63 / $3,705.02 / $6,670.60
| Facility | | $2,295.63 | $3,705.02 | $6,670.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,284.55 / $2,976.10 / $4,497.51
| Professional | | $2,284.55 | $2,976.10 | $4,497.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,700.00 / $6,325.00 / $8,816.00
| Facility | | $4,700.00 | $6,325.00 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,671.82 / $3,779.02 / $5,112.34
| Professional | | $1,671.82 | $3,779.02 | $5,112.34 |