- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,128.02 / $5,598.37 / $8,144.66
| Facility | | $4,128.02 | $5,598.37 | $8,144.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,128.02 / $4,128.02 / $4,540.82
| Professional | | $4,128.02 | $4,128.02 | $4,540.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.80 / $5,491.05 / $20,640.09
| Facility | | $52.80 | $5,491.05 | $20,640.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,128.02 / $4,128.02 / $17,614.63
| Professional | | $4,128.02 | $4,128.02 | $17,614.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,425.24 / $5,069.21 / $9,849.45
| Facility | | $4,425.24 | $5,069.21 | $9,849.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,989.64 / $4,128.02 / $4,128.02
| Facility | | $3,989.64 | $4,128.02 | $4,128.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,128.02 / $4,128.02 / $4,128.02
| Professional | | $4,128.02 | $4,128.02 | $4,128.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,909.00 / $5,363.22 / $8,251.10
| Facility | | $1,909.00 | $5,363.22 | $8,251.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.28 / $116.28 / $4,128.02
| Professional | | $116.28 | $116.28 | $4,128.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.68 / $89.68 / $103.80
| Professional | | $89.68 | $89.68 | $103.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,491.05 / $20,640.09 / $20,640.09
| Facility | | $5,491.05 | $20,640.09 | $20,640.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,128.02 / $4,375.70 / $17,614.63
| Professional | | $4,128.02 | $4,375.70 | $17,614.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,843.39 / $4,128.02 / $5,347.07
| Professional | | $3,843.39 | $4,128.02 | $5,347.07 |