- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,083.97 / $8,477.27 / $19,276.96
| Facility | | $4,083.97 | $8,477.27 | $19,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $949.57 / $949.57 / $5,463.96
| Professional | | $949.57 | $949.57 | $5,463.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,810.78 / $8,958.04 / $17,327.75
| Facility | | $6,810.78 | $8,958.04 | $17,327.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $927.41 / $1,580.81 / $2,107.77
| Professional | | $927.41 | $1,580.81 | $2,107.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,634.43 / $4,634.43 / $4,634.43
| Facility | | $4,634.43 | $4,634.43 | $4,634.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,647.85 / $2,357.41 / $3,160.41
| Professional | | $1,647.85 | $2,357.41 | $3,160.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $949.57 / $1,709.23 / $8,632.00
| Facility | | $949.57 | $1,709.23 | $8,632.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,262.34 / $2,087.73 / $3,019.21
| Professional | | $1,262.34 | $2,087.73 | $3,019.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,268.10 / $2,416.35 / $5,870.28
| Facility | | $1,268.10 | $2,416.35 | $5,870.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,643.47 / $2,271.89 / $3,160.41
| Professional | | $1,643.47 | $2,271.89 | $3,160.41 |
- 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
- $1,262.34 / $2,262.91 / $2,718.91
| Professional | | $1,262.34 | $2,262.91 | $2,718.91 |