- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,928.96 / $8,477.27 / $20,928.72
| Facility | | $2,928.96 | $8,477.27 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,928.96 / $2,928.96 / $17,016.90
| Professional | | $2,928.96 | $2,928.96 | $17,016.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,018.72 / $10,546.81 / $20,400.93
| Facility | | $8,018.72 | $10,546.81 | $20,400.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,823.02 / $4,811.97 / $6,415.96
| Professional | | $2,823.02 | $4,811.97 | $6,415.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,653.00 / $7,152.14 / $9,704.93
| Professional | | $5,653.00 | $7,152.14 | $9,704.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,928.96 / $5,311.43 / $9,696.00
| Facility | | $2,928.96 | $5,311.43 | $9,696.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,955.19 / $6,253.50 / $8,916.57
| Professional | | $3,955.19 | $6,253.50 | $8,916.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,647.19 / $7,310.77 / $10,047.70
| Facility | | $3,647.19 | $7,310.77 | $10,047.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,494.91 / $6,744.32 / $9,704.93
| Professional | | $5,494.91 | $6,744.32 | $9,704.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,158.00 / $9,696.00 / $15,622.00
| Facility | | $8,158.00 | $9,696.00 | $15,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,866.93 / $6,543.30 / $8,518.86
| Professional | | $3,866.93 | $6,543.30 | $8,518.86 |