- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,041.74 / $8,128.31
| Facility | | $2,041.74 | $2,041.74 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,041.74 / $2,398.83
| Professional | | $1,412.54 | $2,041.74 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,840.32 / $53,703.18 / $131,825.67
| Facility | | $28,840.32 | $53,703.18 | $131,825.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,585.78 / $7,943.28 / $7,943.28
| Professional | | $7,585.78 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $3,715.35
| Facility | | $3,715.35 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $4,168.69 / $10,471.29
| Professional | | $4,168.69 | $4,168.69 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,691.53 / $4,365.16
| Facility | | $1,737.80 | $2,691.53 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,981.07 / $12,022.64
| Professional | | $2,187.76 | $3,981.07 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,311.31 / $9,120.11
| Facility | | $1,548.82 | $3,311.31 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,388.44 / $7,079.46
| Professional | | $2,187.76 | $3,388.44 | $7,079.46 |