- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $20,928.72
| Facility | | $4,241.22 | $10,431.19 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,286.67 / $2,286.67 / $13,557.30
| Professional | | $2,286.67 | $2,286.67 | $13,557.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,424.50 / $24,233.27 / $46,874.97
| Facility | | $18,424.50 | $24,233.27 | $46,874.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,179.27 / $3,714.65 / $4,952.88
| Professional | | $2,179.27 | $3,714.65 | $4,952.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,303.63 / $5,643.62 / $7,654.07
| Professional | | $3,303.63 | $5,643.62 | $7,654.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,413.60 / $4,001.69 / $13,909.00
| Facility | | $2,413.60 | $4,001.69 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,164.04 / $5,419.62 / $18,490.64
| Professional | | $3,164.04 | $5,419.62 | $18,490.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,039.41 / $5,592.40 / $7,654.07
| Facility | | $3,039.41 | $5,592.40 | $7,654.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,039.41 / $5,592.40 / $6,967.84
| Professional | | $3,039.41 | $5,592.40 | $6,967.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,847.58 / $5,232.84 / $6,814.86
| Professional | | $2,847.58 | $5,232.84 | $6,814.86 |