- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $21,899.37
| Facility | | $4,241.22 | $10,431.19 | $21,899.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,320.11 / $1,320.11 / $7,134.56
| Professional | | $1,320.11 | $1,320.11 | $7,134.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,952.65 / $9,144.62 / $17,688.66
| Facility | | $6,952.65 | $9,144.62 | $17,688.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,274.82 / $2,173.00 / $2,897.32
| Professional | | $1,274.82 | $2,173.00 | $2,897.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,195.00 / $3,230.62 / $4,331.08
| Professional | | $2,195.00 | $3,230.62 | $4,331.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,320.11 / $2,310.19 / $8,220.00
| Facility | | $1,320.11 | $2,310.19 | $8,220.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,772.59 / $2,931.59 / $4,004.84
| Professional | | $1,772.59 | $2,931.59 | $4,004.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,699.56 / $3,252.84 / $4,516.53
| Facility | | $1,699.56 | $3,252.84 | $4,516.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,452.25 / $2,988.15 / $4,331.08
| Professional | | $2,452.25 | $2,988.15 | $4,331.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,772.59 / $2,934.28 / $3,817.88
| Professional | | $1,772.59 | $2,934.28 | $3,817.88 |