- 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
- $1,457.51 / $1,520.00 / $2,714.52
| Professional | | $1,457.51 | $1,520.00 | $2,714.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,219.04 / $16,264.47 / $28,543.08
| Facility | | $11,219.04 | $16,264.47 | $28,543.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,405.29 / $2,395.38 / $3,193.84
| Professional | | $1,405.29 | $2,395.38 | $3,193.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,011.46 / $3,549.05 / $5,146.39
| Professional | | $2,011.46 | $3,549.05 | $5,146.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,457.51 / $2,477.77 / $3,567.59
| Facility | | $1,457.51 | $2,477.77 | $3,567.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,246.33 / $3,364.99 / $13,253.41
| Professional | | $2,246.33 | $3,364.99 | $13,253.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,577.00 / $3,628.06 / $4,777.25
| Facility | | $2,577.00 | $3,628.06 | $4,777.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,411.44 / $3,628.06 / $4,757.96
| Professional | | $2,411.44 | $3,628.06 | $4,757.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.00 / $2,115.00 / $4,217.30
| Professional | | $11.00 | $2,115.00 | $4,217.30 |
- 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
- $2,246.33 / $3,490.79 / $4,193.14
| Professional | | $2,246.33 | $3,490.79 | $4,193.14 |