- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,008.96 / $7,976.50 / $9,412.27
| Facility | | $3,008.96 | $7,976.50 | $9,412.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,207.86 / $1,845.99 / $1,937.15
| Professional | | $1,207.86 | $1,845.99 | $1,937.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,777.62 / $1,777.62 / $1,777.62
| Professional | | $1,777.62 | $1,777.62 | $1,777.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,162.77 / $3,122.69 / $7,562.76
| Facility | | $2,162.77 | $3,122.69 | $7,562.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,984.78 / $10,984.78 / $10,984.78
| Professional | | $10,984.78 | $10,984.78 | $10,984.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,392.94 / $3,076.65 / $5,629.13
| Professional | | $2,392.94 | $3,076.65 | $5,629.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,507.38 / $9,412.27 / $9,412.27
| Facility | | $3,507.38 | $9,412.27 | $9,412.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,495.71 / $1,937.15 / $9,412.27
| Professional | | $1,495.71 | $1,937.15 | $9,412.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,372.92 / $3,418.50 / $4,558.00
| Professional | | $3,372.92 | $3,418.50 | $4,558.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.40 / $3,527.89 / $7,562.76
| Facility | | $2,218.40 | $3,527.89 | $7,562.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,984.78 / $10,984.78 / $10,984.78
| Professional | | $10,984.78 | $10,984.78 | $10,984.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,279.00 / $2,279.00 / $2,506.90
| Facility | | $2,279.00 | $2,279.00 | $2,506.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,279.00 / $2,279.00 / $2,506.90
| Professional | | $2,279.00 | $2,279.00 | $2,506.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $957.18 / $1,367.40 / $3,418.50
| Professional | | $957.18 | $1,367.40 | $3,418.50 |