- 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
- $1,397.86 / $1,397.86 / $8,236.71
| Professional | | $1,397.86 | $1,397.86 | $8,236.71 |
- 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
- $1,346.86 / $2,295.80 / $3,061.07
| Professional | | $1,346.86 | $2,295.80 | $3,061.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,102.53 / $3,490.52 / $4,692.76
| Professional | | $2,102.53 | $3,490.52 | $4,692.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,649.87 / $2,797.11 / $13,909.00
| Facility | | $1,649.87 | $2,797.11 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,932.19 / $3,536.59 / $11,481.28
| Professional | | $1,932.19 | $3,536.59 | $11,481.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,806.75 / $3,490.52 / $4,692.76
| Facility | | $2,806.75 | $3,490.52 | $4,692.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,806.75 / $3,628.27 / $4,602.50
| Professional | | $2,806.75 | $3,628.27 | $4,602.50 |
- 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
- $1,932.19 / $3,464.57 / $4,298.84
| Professional | | $1,932.19 | $3,464.57 | $4,298.84 |