- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $7,079.46 / $13,803.84
| Facility | | $2,137.96 | $7,079.46 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,290.87 / $5,623.41
| Professional | | $1,995.26 | $2,290.87 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,890.45 / $6,025.60
| Professional | | $2,398.83 | $3,890.45 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,090.30 / $5,495.41
| Professional | | $2,187.76 | $3,090.30 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $3,801.89 / $5,011.87
| Professional | | $3,801.89 | $3,801.89 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,884.03 / $4,466.84
| Facility | | $2,137.96 | $2,884.03 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,715.35 / $4,786.30
| Professional | | $2,951.21 | $3,715.35 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $21,379.62 / $28,840.32
| Facility | | $9,332.54 | $21,379.62 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,454.71 / $4,677.35
| Professional | | $1,862.09 | $2,454.71 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $34,673.69 / $34,673.69
| Facility | | $56.23 | $34,673.69 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,379.62 / $21,379.62 / $21,379.62
| Professional | | $21,379.62 | $21,379.62 | $21,379.62 |