- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,215.55 / $8,477.27 / $20,928.72
| Facility | | $2,215.55 | $8,477.27 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,215.55 / $2,215.55 / $13,079.90
| Professional | | $2,215.55 | $2,215.55 | $13,079.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,766.83 / $15,476.59 / $29,936.73
| Facility | | $11,766.83 | $15,476.59 | $29,936.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,147.76 / $3,660.94 / $4,881.27
| Professional | | $2,147.76 | $3,660.94 | $4,881.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,759.00 / $5,417.86 / $7,344.24
| Professional | | $3,759.00 | $5,417.86 | $7,344.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,215.55 / $3,877.21 / $6,425.77
| Facility | | $2,215.55 | $3,877.21 | $6,425.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,968.25 / $4,909.03 / $6,738.90
| Professional | | $2,968.25 | $4,909.03 | $6,738.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,902.84 / $5,649.21 / $8,097.60
| Facility | | $2,902.84 | $5,649.21 | $8,097.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,762.08 / $5,315.08 / $7,344.24
| Professional | | $3,762.08 | $5,315.08 | $7,344.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,503.92 / $4,365.80 / $4,860.29
| Professional | | $2,503.92 | $4,365.80 | $4,860.29 |
- 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
- $2,968.25 / $4,909.03 / $6,086.82
| Professional | | $2,968.25 | $4,909.03 | $6,086.82 |