- 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
- $1,235.44 / $1,235.44 / $7,153.62
| Professional | | $1,235.44 | $1,235.44 | $7,153.62 |
- 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
- $1,192.14 / $2,032.05 / $2,709.42
| Professional | | $1,192.14 | $2,032.05 | $2,709.42 |
- 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
- $1,991.00 / $3,029.92 / $4,066.96
| Professional | | $1,991.00 | $3,029.92 | $4,066.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,235.44 / $2,213.98 / $8,632.00
| Facility | | $1,235.44 | $2,213.98 | $8,632.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,660.13 / $2,745.59 / $3,748.08
| Professional | | $1,660.13 | $2,745.59 | $3,748.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,658.16 / $3,109.44 / $5,870.28
| Facility | | $1,658.16 | $3,109.44 | $5,870.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,105.00 / $2,838.97 / $4,066.96
| Professional | | $2,105.00 | $2,838.97 | $4,066.96 |
- 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
- $1,660.13 / $2,554.04 / $3,413.53
| Professional | | $1,660.13 | $2,554.04 | $3,413.53 |