- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $3,890.45 / $3,890.45
| Facility | | $3,890.45 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $4,677.35 / $8,511.38
| Professional | | $3,890.45 | $4,677.35 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,388.44 / $36,307.81
| Facility | | $1,479.11 | $3,388.44 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,918.31 / $10,715.19 / $15,848.93
| Professional | | $6,918.31 | $10,715.19 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $14,791.08 / $35,481.34
| Facility | | $9,332.54 | $14,791.08 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,606.93 / $11,220.18 / $17,378.01
| Professional | | $6,606.93 | $11,220.18 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $14,125.38 / $27,542.29
| Facility | | $11,481.54 | $14,125.38 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,079.46 / $10,000.00 / $15,848.93
| Professional | | $7,079.46 | $10,000.00 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,623.41 / $11,481.54
| Facility | | $2,754.23 | $5,623.41 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $8,511.38 / $31,622.78
| Professional | | $4,466.84 | $8,511.38 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,311.31 / $8,511.38
| Facility | | $794.33 | $3,311.31 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $7,762.47 / $14,454.40
| Professional | | $4,365.16 | $7,762.47 | $14,454.40 |