- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,467.27 / $8,477.27 / $20,928.72
| Facility | | $2,467.27 | $8,477.27 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,467.27 / $2,467.27 / $14,309.50
| Professional | | $2,467.27 | $2,467.27 | $14,309.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,368.80 / $18,898.90 / $36,556.58
| Facility | | $14,368.80 | $18,898.90 | $36,556.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,379.36 / $4,055.73 / $5,407.64
| Professional | | $2,379.36 | $4,055.73 | $5,407.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,150.77 / $6,036.47 / $8,153.14
| Professional | | $4,150.77 | $6,036.47 | $8,153.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,467.27 / $4,317.72 / $9,696.00
| Facility | | $2,467.27 | $4,317.72 | $9,696.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,323.55 / $4,985.33 / $7,497.92
| Professional | | $3,323.55 | $4,985.33 | $7,497.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,228.35 / $5,733.85 / $8,455.11
| Facility | | $3,228.35 | $5,733.85 | $8,455.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,350.00 / $5,489.42 / $8,153.14
| Professional | | $4,350.00 | $5,489.42 | $8,153.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,148.00 / $9,696.00 / $15,622.00
| Facility | | $8,148.00 | $9,696.00 | $15,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,323.55 / $5,024.56 / $6,744.26
| Professional | | $3,323.55 | $5,024.56 | $6,744.26 |