- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,235.94 / $8,709.64
| Facility | | $2,041.74 | $3,235.94 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,344.23 / $6,025.60
| Professional | | $1,905.46 | $2,344.23 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,951.21 / $5,248.07
| Professional | | $2,398.83 | $2,951.21 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,090.30 / $5,128.61
| Professional | | $2,187.76 | $3,090.30 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,754.23 / $4,168.69
| Facility | | $2,041.74 | $2,754.23 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $3,890.45 / $5,248.07
| Professional | | $10.96 | $3,890.45 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $3,890.45 / $6,918.31
| Facility | | $1,174.90 | $3,890.45 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,570.40 / $4,570.88
| Professional | | $1,862.09 | $2,570.40 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $28,183.83 / $28,183.83
| Facility | | $56.23 | $28,183.83 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,791.08 / $14,791.08 / $19,054.61
| Professional | | $14,791.08 | $14,791.08 | $19,054.61 |