- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $20,928.72
| Facility | | $4,241.22 | $10,431.19 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,214.66 / $1,214.66 / $1,214.66
| Professional | | $1,214.66 | $1,214.66 | $1,214.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,731.81 / $33,844.37 / $65,465.93
| Facility | | $25,731.81 | $33,844.37 | $65,465.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,042.32 / $1,776.69 / $2,368.92
| Professional | | $1,042.32 | $1,776.69 | $2,368.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,511.63 / $2,537.44 / $3,311.00
| Professional | | $1,511.63 | $2,537.44 | $3,311.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,214.66 / $2,125.66 / $26,758.72
| Facility | | $1,214.66 | $2,125.66 | $26,758.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,682.89 / $2,768.74 / $3,830.15
| Professional | | $1,682.89 | $2,768.74 | $3,830.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,291.21 / $2,603.08 / $3,311.00
| Facility | | $2,291.21 | $2,603.08 | $3,311.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,291.21 / $2,613.50 / $3,458.97
| Professional | | $2,291.21 | $2,613.50 | $3,458.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,682.89 / $2,873.86 / $3,624.68
| Professional | | $1,682.89 | $2,873.86 | $3,624.68 |