- 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
- $1,170.33 / $1,170.33 / $6,762.54
| Professional | | $1,170.33 | $1,170.33 | $6,762.54 |
- 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
- $1,130.23 / $1,926.53 / $2,568.71
| Professional | | $1,130.23 | $1,926.53 | $2,568.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,968.00 / $2,862.45 / $3,837.48
| Professional | | $1,968.00 | $2,862.45 | $3,837.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.33 / $2,048.08 / $8,220.00
| Facility | | $1,170.33 | $2,048.08 | $8,220.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,566.73 / $2,591.14 / $3,542.67
| Professional | | $1,566.73 | $2,591.14 | $3,542.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,505.76 / $2,881.88 / $3,996.13
| Facility | | $1,505.76 | $2,881.88 | $3,996.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,172.78 / $2,638.70 / $3,837.48
| Professional | | $2,172.78 | $2,638.70 | $3,837.48 |
- 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
- $1,566.73 / $2,591.14 / $3,374.50
| Professional | | $1,566.73 | $2,591.14 | $3,374.50 |