- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $11,220.18 / $15,488.17
| Facility | | $3,467.37 | $11,220.18 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,265.80 / $5,011.87
| Professional | | $3,467.37 | $4,265.80 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $13,489.63 / $23,988.33
| Facility | | $5,495.41 | $13,489.63 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $5,011.87 / $18,620.87
| Professional | | $3,019.95 | $5,011.87 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $10,232.93 / $14,454.40
| Facility | | $8,128.31 | $10,232.93 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,890.45 / $7,943.28
| Facility | | $3,388.44 | $3,890.45 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,025.60 / $6,025.60 / $7,244.36
| Professional | | $6,025.60 | $6,025.60 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,244.36 / $7,244.36 / $8,511.38
| Professional | | $7,244.36 | $7,244.36 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,011.87 / $10,715.19
| Professional | | $5,011.87 | $5,011.87 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $13,489.63 / $23,988.33
| Facility | | $5,495.41 | $13,489.63 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $5,011.87 / $18,620.87
| Professional | | $3,019.95 | $5,011.87 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $5,011.87 / $6,025.60
| Facility | | $3,019.95 | $5,011.87 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $5,011.87 / $10,232.93
| Professional | | $3,019.95 | $5,011.87 | $10,232.93 |