- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,752.78 / $9,185.68 / $20,928.72
| Facility | | $3,752.78 | $9,185.68 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $651.08 / $708.34 / $2,022.81
| Professional | | $651.08 | $708.34 | $2,022.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,677.94 / $1,677.94 / $5,181.28
| Professional | | $1,677.94 | $1,677.94 | $5,181.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,018.72 / $10,546.81 / $20,400.93
| Facility | | $8,018.72 | $10,546.81 | $20,400.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.88 / $1,162.30 / $1,549.74
| Professional | | $681.88 | $1,162.30 | $1,549.74 |
- 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
- $1,243.00 / $1,707.55 / $2,289.21
| Professional | | $1,243.00 | $1,707.55 | $2,289.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $705.26 / $1,234.21 / $8,816.00
| Facility | | $705.26 | $1,234.21 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.34 / $1,543.59 / $2,115.54
| Professional | | $933.34 | $1,543.59 | $2,115.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $1,866.07 / $7,775.41
| Facility | | $1,285.00 | $1,866.07 | $7,775.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,296.14 / $1,667.06 / $2,289.21
| Professional | | $1,296.14 | $1,667.06 | $2,289.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,569.59 / $7,221.00 / $8,816.00
| Facility | | $5,569.59 | $7,221.00 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.34 / $1,435.90 / $2,010.26
| Professional | | $933.34 | $1,435.90 | $2,010.26 |