- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $10,506.16 / $21,899.37
| Facility | | $5,463.36 | $10,506.16 | $21,899.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,383.31 / $1,383.31 / $7,729.66
| Professional | | $1,383.31 | $1,383.31 | $7,729.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,193.47 / $8,393.75 / $15,757.21
| Facility | | $6,193.47 | $8,393.75 | $15,757.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.20 / $2,260.55 / $3,014.09
| Professional | | $1,326.20 | $2,260.55 | $3,014.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,763.65 / $3,434.44 / $4,334.99
| Professional | | $2,763.65 | $3,434.44 | $4,334.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,383.31 / $2,420.79 / $9,855.12
| Facility | | $1,383.31 | $2,420.79 | $9,855.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,935.78 / $3,314.39 / $11,082.32
| Professional | | $1,935.78 | $3,314.39 | $11,082.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,733.38 / $3,676.91 / $5,383.60
| Facility | | $2,733.38 | $3,676.91 | $5,383.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,423.77 / $3,314.39 / $4,334.99
| Professional | | $2,423.77 | $3,314.39 | $4,334.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $6.00 / $3,847.40
| Professional | | $6.00 | $6.00 | $3,847.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $7,531.16 / $8,816.00
| Facility | | $6,178.00 | $7,531.16 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,935.78 / $3,253.77 / $3,902.40
| Professional | | $1,935.78 | $3,253.77 | $3,902.40 |