- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $2,691.53
| Facility | | $2,691.53 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,691.53 / $4,365.16
| Professional | | $2,344.23 | $2,691.53 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $30,199.52 / $61,659.50
| Facility | | $16,595.87 | $30,199.52 | $61,659.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $6,456.54 / $10,000.00
| Professional | | $4,365.16 | $6,456.54 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $9,772.37 / $22,908.68
| Facility | | $6,918.31 | $9,772.37 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $7,762.47 / $11,748.98
| Professional | | $4,677.35 | $7,762.47 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $9,332.54 / $18,197.01
| Facility | | $7,413.10 | $9,332.54 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,011.87 / $6,606.93 / $10,471.29
| Professional | | $5,011.87 | $6,606.93 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $4,677.35 / $7,943.28
| Facility | | $2,691.53 | $4,677.35 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,128.61 / $14,791.08
| Professional | | $2,570.40 | $5,128.61 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $8,128.31 / $28,183.83
| Facility | | $1,584.89 | $8,128.31 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,897.79 / $9,549.93
| Professional | | $2,630.27 | $4,897.79 | $9,549.93 |