- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,778.28 / $7,079.46
| Facility | | $1,778.28 | $1,778.28 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,862.09 / $2,818.38
| Professional | | $1,548.82 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $13,803.84 / $34,673.69
| Facility | | $7,943.28 | $13,803.84 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,801.89 / $6,165.95
| Professional | | $2,630.27 | $3,801.89 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $6,165.95 / $14,791.08
| Facility | | $4,365.16 | $6,165.95 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $5,248.07 / $7,762.47
| Professional | | $3,388.44 | $5,248.07 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $5,888.44 / $11,481.54
| Facility | | $4,786.30 | $5,888.44 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,365.16 / $6,606.93
| Professional | | $3,162.28 | $4,365.16 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,548.13 / $11,748.98
| Facility | | $1,862.09 | $3,548.13 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,467.37 / $9,332.54
| Professional | | $2,041.74 | $3,467.37 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $8,709.64 / $14,791.08
| Facility | | $1,584.89 | $8,709.64 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,467.37 / $6,760.83
| Professional | | $2,041.74 | $3,467.37 | $6,760.83 |