- 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
- $2,164.29 / $2,164.29 / $12,792.90
| Professional | | $2,164.29 | $2,164.29 | $12,792.90 |
- 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
- $2,098.15 / $3,576.40 / $4,768.54
| Professional | | $2,098.15 | $3,576.40 | $4,768.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,372.35 / $5,433.60 / $7,107.24
| Professional | | $4,372.35 | $5,433.60 | $7,107.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,490.34 / $3,787.51 / $7,856.00
| Facility | | $2,490.34 | $3,787.51 | $7,856.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,902.71 / $5,433.96 / $18,482.93
| Professional | | $2,902.71 | $5,433.96 | $18,482.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,372.35 / $5,455.03 / $7,905.74
| Facility | | $4,372.35 | $5,455.03 | $7,905.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,359.57 / $5,433.96 / $7,107.24
| Professional | | $3,359.57 | $5,433.96 | $7,107.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.00 / $4,517.30 / $6,380.20
| Professional | | $11.00 | $4,517.30 | $6,380.20 |
- 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
- $3,125.99 / $5,203.43 / $6,486.98
| Professional | | $3,125.99 | $5,203.43 | $6,486.98 |