- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,704.26 / $2,704.26 / $2,704.26
| Facility | | $2,704.26 | $2,704.26 | $2,704.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,704.26 / $2,727.90 / $5,125.92
| Professional | | $2,704.26 | $2,727.90 | $5,125.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,312.87 / $12,823.06 / $33,201.65
| Facility | | $4,312.87 | $12,823.06 | $33,201.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,784.85 / $4,528.51 / $6,044.21
| Professional | | $2,784.85 | $4,528.51 | $6,044.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,757.99 / $7,992.28 / $10,292.54
| Facility | | $6,757.99 | $7,992.28 | $10,292.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,458.07 / $5,491.61 / $5,491.61
| Professional | | $4,458.07 | $5,491.61 | $5,491.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,052.23 / $4,052.23 / $4,549.05
| Facility | | $4,052.23 | $4,052.23 | $4,549.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,958.13 / $4,052.23 / $7,323.00
| Professional | | $2,958.13 | $4,052.23 | $7,323.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,011.18 / $5,011.18 / $5,261.74
| Professional | | $5,011.18 | $5,011.18 | $5,261.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,199.45 / $4,199.45 / $4,199.45
| Professional | | $4,199.45 | $4,199.45 | $4,199.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,823.06 / $33,201.65 / $33,201.65
| Facility | | $12,823.06 | $33,201.65 | $33,201.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,417.67 / $3,308.40 / $6,044.21
| Professional | | $2,417.67 | $3,308.40 | $6,044.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,356.42 / $3,308.40 / $5,582.09
| Professional | | $2,356.42 | $3,308.40 | $5,582.09 |