- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $7,943.28 / $9,549.93
| Facility | | $5,754.40 | $7,943.28 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,365.16 / $10,232.93
| Professional | | $3,388.44 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $6,760.83 / $10,000.00
| Professional | | $660.69 | $6,760.83 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,370.32 / $7,413.10 / $8,912.51
| Professional | | $5,370.32 | $7,413.10 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $5,248.07 / $8,912.51
| Facility | | $3,801.89 | $5,248.07 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $6,760.83 / $9,332.54
| Professional | | $5,495.41 | $6,760.83 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $6,918.31 / $7,762.47
| Facility | | $5,128.61 | $6,918.31 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,248.07 / $8,709.64
| Facility | | $3,467.37 | $5,248.07 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $7,585.78 / $10,471.29
| Professional | | $79.43 | $7,585.78 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $18,620.87 / $18,620.87
| Facility | | $18,620.87 | $18,620.87 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,918.31 / $8,128.31 / $10,471.29
| Professional | | $6,918.31 | $8,128.31 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $7,585.78 / $31,622.78
| Facility | | $1,412.54 | $7,585.78 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $7,244.36 / $10,964.78
| Professional | | $4,265.80 | $7,244.36 | $10,964.78 |