- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $6,760.83
| Facility | | $1,202.26 | $1,202.26 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,258.93 / $2,290.87
| Professional | | $1,096.48 | $1,258.93 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $16,595.87 / $32,359.37
| Facility | | $7,244.36 | $16,595.87 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,951.21 / $4,466.84
| Professional | | $1,949.84 | $2,951.21 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,365.16 / $10,471.29
| Facility | | $3,090.30 | $4,365.16 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,548.13 / $5,370.32
| Professional | | $2,137.96 | $3,548.13 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,265.80 / $8,317.64
| Facility | | $3,388.44 | $4,265.80 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,019.95 / $4,786.30
| Professional | | $2,290.87 | $3,019.95 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,454.71 / $12,022.64
| Facility | | $1,258.93 | $2,454.71 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,290.87 / $6,606.93
| Professional | | $1,148.15 | $2,290.87 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $9,332.54 / $13,182.57
| Facility | | $4,570.88 | $9,332.54 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,187.76 / $4,365.16
| Professional | | $1,174.90 | $2,187.76 | $4,365.16 |