- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $5,754.40 / $5,754.40
| Facility | | $5,754.40 | $5,754.40 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,897.79 / $6,760.83 / $10,000.00
| Professional | | $4,897.79 | $6,760.83 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $8,511.38 / $8,912.51
| Facility | | $6,918.31 | $8,511.38 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,754.40 / $8,317.64
| Professional | | $2,884.03 | $5,754.40 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,456.54 / $9,120.11 / $9,120.11
| Professional | | $6,456.54 | $9,120.11 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $8,128.31 / $8,709.64
| Facility | | $8,128.31 | $8,128.31 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $8,128.31 / $19,054.61
| Professional | | $977.24 | $8,128.31 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $11,481.54 / $11,481.54
| Professional | | $3,548.13 | $11,481.54 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,754.40 / $5,754.40 / $5,754.40
| Professional | | $5,754.40 | $5,754.40 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $8,511.38 / $8,912.51
| Facility | | $6,918.31 | $8,511.38 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,754.40 / $8,511.38
| Professional | | $2,884.03 | $5,754.40 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.89 / $794.33 / $5,623.41
| Facility | | $5.89 | $794.33 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,677.35 / $11,481.54
| Professional | | $2,884.03 | $4,677.35 | $11,481.54 |