- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $7,943.28 / $14,454.40
| Facility | | $2,691.53 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,479.11 / $2,818.38
| Professional | | $1,288.25 | $1,479.11 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $7,244.36 / $14,125.38
| Facility | | $5,495.41 | $7,244.36 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,137.96 / $2,818.38
| Professional | | $1,258.93 | $2,137.96 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $2,630.27 / $4,570.88
| Professional | | $575.44 | $2,630.27 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,995.26 / $4,168.69
| Facility | | $1,288.25 | $1,995.26 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,884.03 / $10,471.29
| Professional | | $1,621.81 | $2,884.03 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,311.31 / $4,570.88
| Professional | | $2,691.53 | $3,311.31 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,090.30 / $4,570.88
| Professional | | $2,454.71 | $3,090.30 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $1,819.70 / $3,715.35
| Professional | | $6.03 | $1,819.70 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,570.88 / $13,803.84
| Facility | | $3,235.94 | $4,570.88 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,187.76 / $3,801.89
| Professional | | $1,548.82 | $2,187.76 | $3,801.89 |