- 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
- $1,528.01 / $1,528.01 / $8,988.54
| Professional | | $1,528.01 | $1,528.01 | $8,988.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,461.16 / $11,467.05 / $21,526.57
| Facility | | $8,461.16 | $11,467.05 | $21,526.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,482.65 / $2,527.23 / $3,369.65
| Professional | | $1,482.65 | $2,527.23 | $3,369.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,089.67 / $3,839.59 / $5,031.60
| Professional | | $3,089.67 | $3,839.59 | $5,031.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.99 / $2,903.22 / $8,632.00
| Facility | | $1,758.99 | $2,903.22 | $8,632.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,038.78 / $3,846.98 / $12,731.92
| Professional | | $2,038.78 | $3,846.98 | $12,731.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,176.17 / $3,276.96 / $5,031.60
| Facility | | $2,176.17 | $3,276.96 | $5,031.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,584.00 / $3,790.97 / $5,031.60
| Professional | | $2,584.00 | $3,790.97 | $5,031.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.00 / $2,361.60 / $4,503.80
| Professional | | $11.00 | $2,361.60 | $4,503.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $7,441.00 / $8,816.00
| Facility | | $6,178.00 | $7,441.00 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,195.61 / $3,654.74 / $4,634.53
| Professional | | $2,195.61 | $3,654.74 | $4,634.53 |