- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,012.00 / $6,298.62 / $10,255.42
| Facility | | $5,012.00 | $6,298.62 | $10,255.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,648.22 / $1,973.28 / $5,083.20
| Professional | | $1,648.22 | $1,973.28 | $5,083.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,255.80 / $6,443.47 / $6,631.15
| Facility | | $6,255.80 | $6,443.47 | $6,631.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,438.96 / $3,989.38 / $5,577.81
| Professional | | $2,438.96 | $3,989.38 | $5,577.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,029.94 / $1,030.96 / $1,694.72
| Professional | | $1,029.94 | $1,030.96 | $1,694.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,973.28 / $3,488.12 / $10,188.00
| Facility | | $1,973.28 | $3,488.12 | $10,188.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,940.92 / $3,792.94 / $8,129.82
| Professional | | $1,940.92 | $3,792.94 | $8,129.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,488.12 / $4,089.11 / $5,577.81
| Facility | | $3,488.12 | $4,089.11 | $5,577.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,438.96 / $4,089.11 / $5,577.81
| Professional | | $2,438.96 | $4,089.11 | $5,577.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.00 / $9,259.00 / $14,242.22
| Facility | | $8,220.00 | $9,259.00 | $14,242.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,003.94 / $3,391.50 / $6,316.68
| Professional | | $2,003.94 | $3,391.50 | $6,316.68 |