- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,298.56 / $22,045.00 / $32,521.30
| Facility | | $6,298.56 | $22,045.00 | $32,521.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,480.40 / $6,298.56 / $6,609.60
| Professional | | $2,480.40 | $6,298.56 | $6,609.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,065.28 / $6,065.28 / $6,065.28
| Professional | | $6,065.28 | $6,065.28 | $6,065.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,379.42 / $11,487.24 / $25,804.67
| Facility | | $7,379.42 | $11,487.24 | $25,804.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,094.12 / $8,304.87 / $17,587.30
| Professional | | $4,094.12 | $8,304.87 | $17,587.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,626.72 / $10,497.60 / $14,774.40
| Professional | | $4,626.72 | $10,497.60 | $14,774.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,609.60 / $22,045.00 / $32,114.90
| Facility | | $6,609.60 | $22,045.00 | $32,114.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,480.40 / $6,376.32 / $32,114.90
| Professional | | $2,480.40 | $6,376.32 | $32,114.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,508.48 / $11,664.00 / $15,552.00
| Professional | | $11,508.48 | $11,664.00 | $15,552.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,568.87 / $12,936.74 / $25,804.67
| Facility | | $7,568.87 | $12,936.74 | $25,804.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,052.80 / $8,324.09 / $24,972.26
| Professional | | $5,052.80 | $8,324.09 | $24,972.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,776.00 / $7,776.00 / $8,553.60
| Facility | | $7,776.00 | $7,776.00 | $8,553.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,776.00 / $7,776.00 / $8,553.60
| Professional | | $7,776.00 | $7,776.00 | $8,553.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,265.92 / $4,665.60 / $10,886.40
| Professional | | $3,265.92 | $4,665.60 | $10,886.40 |