- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,607.06 / $2,607.06 / $2,607.06
| Facility | | $2,607.06 | $2,607.06 | $2,607.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,496.48 / $2,701.15 / $4,617.01
| Professional | | $2,496.48 | $2,701.15 | $4,617.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,166.47 / $10,629.47 / $21,619.73
| Facility | | $4,166.47 | $10,629.47 | $21,619.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,642.31 / $7,925.41 / $9,612.37
| Professional | | $4,642.31 | $7,925.41 | $9,612.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,047.40 / $9,438.43 / $22,705.41
| Facility | | $6,047.40 | $9,438.43 | $22,705.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,723.35 / $8,458.79 / $11,715.93
| Professional | | $4,723.35 | $8,458.79 | $11,715.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,240.60 / $8,613.18 / $17,878.28
| Facility | | $5,240.60 | $8,613.18 | $17,878.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,723.35 / $7,774.41 / $10,711.81
| Professional | | $4,723.35 | $7,774.41 | $10,711.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,605.37 / $4,212.30 / $7,916.67
| Facility | | $2,605.37 | $4,212.30 | $7,916.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,133.80 / $6,370.16 / $20,261.75
| Professional | | $3,133.80 | $6,370.16 | $20,261.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $3,500.00 / $8,152.00
| Facility | | $796.00 | $3,500.00 | $8,152.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,072.97 / $5,697.82 / $10,996.79
| Professional | | $3,072.97 | $5,697.82 | $10,996.79 |