- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,503.52 / $3,503.52 / $3,503.52
| Facility | | $3,503.52 | $3,503.52 | $3,503.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,248.09 / $2,744.42 / $3,503.52
| Professional | | $2,248.09 | $2,744.42 | $3,503.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,167.83 / $1,167.83 / $11,678.40
| Professional | | $1,167.83 | $1,167.83 | $11,678.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,442.54 / $4,442.54 / $4,442.54
| Facility | | $4,442.54 | $4,442.54 | $4,442.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,034.39 / $9,388.82 / $14,402.68
| Facility | | $8,034.39 | $9,388.82 | $14,402.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,455.44 / $7,861.90 / $8,933.98
| Professional | | $3,455.44 | $7,861.90 | $8,933.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.09 / $3,503.52 / $10,218.60
| Facility | | $2,248.09 | $3,503.52 | $10,218.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.09 / $3,503.52 / $10,218.60
| Facility | | $2,248.09 | $3,503.52 | $10,218.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,459.80 / $1,751.76 / $9,003.61
| Professional | | $1,459.80 | $1,751.76 | $9,003.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $70.00 / $8,058.10
| Professional | | $50.00 | $70.00 | $8,058.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.09 / $3,503.52 / $10,218.60
| Facility | | $2,248.09 | $3,503.52 | $10,218.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,874.04 / $6,961.75 / $9,764.33
| Professional | | $4,874.04 | $6,961.75 | $9,764.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,839.20 / $13,868.10 / $13,868.10
| Facility | | $5,839.20 | $13,868.10 | $13,868.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,678.40 / $14,598.00 / $14,598.00
| Professional | | $11,678.40 | $14,598.00 | $14,598.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,217.42 / $6,217.42 / $6,217.42
| Professional | | $6,217.42 | $6,217.42 | $6,217.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,484.98 / $15,941.02 / $15,941.02
| Professional | | $8,484.98 | $15,941.02 | $15,941.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,335.67 / $2,335.67 / $6,335.53
| Facility | | $2,335.67 | $2,335.67 | $6,335.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,313.82 / $1,869.42 / $7,743.04
| Professional | | $1,313.82 | $1,869.42 | $7,743.04 |