- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $8,477.27 / $19,276.96
| Facility | | $4,241.22 | $8,477.27 | $19,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $968.99 / $1,601.11 / $5,233.03
| Professional | | $968.99 | $1,601.11 | $5,233.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,833.84 / $6,306.95 / $12,298.09
| Facility | | $4,833.84 | $6,306.95 | $12,298.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $930.39 / $1,585.91 / $2,114.55
| Professional | | $930.39 | $1,585.91 | $2,114.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,380.56 / $2,380.56 / $2,380.56
| Facility | | $2,380.56 | $2,380.56 | $2,380.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,019.67 / $2,366.13 / $2,957.66
| Professional | | $2,019.67 | $2,366.13 | $2,957.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.93 / $1,961.39 / $8,816.00
| Facility | | $973.93 | $1,961.39 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,305.22 / $1,970.23 / $2,608.69
| Professional | | $1,305.22 | $1,970.23 | $2,608.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,097.98 / $2,409.44 / $3,123.31
| Facility | | $1,097.98 | $2,409.44 | $3,123.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,422.98 / $2,019.67 / $2,773.08
| Professional | | $1,422.98 | $2,019.67 | $2,773.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,694.25 / $5,582.35 / $8,632.00
| Facility | | $4,694.25 | $5,582.35 | $8,632.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,397.52 / $2,104.76 / $2,502.90
| Professional | | $1,397.52 | $2,104.76 | $2,502.90 |